The effect of ileostomy closure timing on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer
https://doi.org/10.24017/science.2021.1.13
Abstract views: 938 / PDF downloads: 610Abstract
This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus. A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.
Keywords:
Stoma closure; Low anterior resection; Low anterior resection syndrome; Rectal cancer; Colon cancer; Radiotherapy
References
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https://doi.org/10.1007/DCR.0b013e3181fd2948
[33] F. Nuytens, D. Develtere, G. Sergeant, I. Parmentier, A. D'Hoore, and M. D'Hondt, "Perioperative radiotherapy is an independent risk factor for major LARS: a cross-sectional observational study," Int. J. Colorectal Dis., vol. 33, no. 8, pp. 1063-1069, 2018.
https://doi.org/10.1007/s00384-018-3043-5
[34] S. Haas et al., "Anal sphincter dysfunction in patients treated with primary radiotherapy for anal cancer: a study with the functional lumen imaging probe," Acta Oncol., vol. 57, no. 4, pp. 465-472, 2018.
https://doi.org/10.1080/0284186X.2018.1438658
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https://doi.org/10.1016/S0140-6736(01)06409-1
[36] R. M. Jiménez-Rodríguez et al., "Is the interval from surgery to ileostomy closure a risk factor for low anterior resection syndrome?," Colorectal Dis., vol. 19, no. 5, pp. 485-490, 2017.
https://doi.org/10.1111/codi.13524
https://doi.org/10.1038/s41598-020-68900-8
[2] Y. Ziv, A. Zbar, Y. Bar-Shavit, and I. Igov, "Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations," Tech. Coloproctol., vol. 17, no. 2, pp. 151-162, 2013.
https://doi.org/10.1007/s10151-012-0909-3
[3] E. H. A. Pieniowski et al., "Low anterior resection syndrome and quality of life after sphincter-sparing rectal cancer surgery: A long-term longitudinal follow-up," Dis. Colon Rectum, vol. 62, no. 1, pp. 14-20, 2019.
https://doi.org/10.1097/DCR.0000000000001228
[4] S. Gadan, H. Floodeen, R. Lindgren, and P. Matthiessen, "Does a defunctioning stoma impair anorectal function after low anterior resection of the rectum for cancer? A 12-year follow-up of a randomized multicenter trial," Dis. Colon Rectum, vol. 60, no. 8, pp. 800-806, 2017.
https://doi.org/10.1097/DCR.0000000000000818
[5] M. J. Kim et al., "Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life," Sci. Rep., vol. 11, no. 1, p. 3538, 2021.
https://doi.org/10.1038/s41598-021-82149-9
[6] D. L. Hughes, J. Cornish, C. Morris, and LARRIS Trial Management Group, "Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome," Int. J. Colorectal Dis., vol. 32, no. 5, pp. 691-697, 2017.
https://doi.org/10.1007/s00384-017-2765-0
[7] C. L. C. Bryant, P. J. Lunniss, C. H. Knowles, M. A. Thaha, and C. L. H. Chan, "Anterior resection syndrome," Lancet Oncol., vol. 13, no. 9, pp. e403-8, 2012.
https://doi.org/10.1016/S1470-2045(12)70236-X
[8] J. A. G. van der Heijden, M. van Heinsbergen, G. Thomas, F. Caers, G. D. Slooter, and A. J. G. Maaskant-Braat, "Implementation of a postoperative screening and treatment guidance for the low anterior resection syndrome: Preliminary results: Preliminary results," Dis. Colon Rectum, vol. 62, no. 9, pp. 1033-1042, 2019.
https://doi.org/10.1097/DCR.0000000000001428
[9] C. Keane, C. Wells, G. O'Grady, and I. P. Bissett, "Defining low anterior resection syndrome: a systematic review of the literature," Colorectal Dis., vol. 19, no. 8, pp. 713-722, 2017.
https://doi.org/10.1111/codi.13767
[10] T. Juul et al., "International validation of the low anterior resection syndrome score," Ann. Surg., vol. 259, no. 4, pp. 728-734, 2014.
https://doi.org/10.1097/SLA.0b013e31828fac0b
[11] T. Juul et al., "Validation of the English translation of the low anterior resection syndrome score," Colorectal Dis., vol. 17, no. 10, pp. 908-916, 2015.
https://doi.org/10.1111/codi.12952
[12] R. O. Perez et al., "Loop ileostomy morbidity: timing of closure matters," Dis. Colon Rectum, vol. 49, no. 10, pp. 1539-1545, 2006.
https://doi.org/10.1007/s10350-006-0645-8
[13] H. B. Neuman, J. Park, S. Fuzesi, and L. K. Temple, "Rectal cancer patients' quality of life with a temporary stoma: shifting perspectives: Shifting perspectives," Dis. Colon Rectum, vol. 55, no. 11, pp. 1117-1124, 2012.
https://doi.org/10.1097/DCR.0b013e3182686213
[14] L. M. Jimenez-Gomez et al., "Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer," Colorectal Dis., vol. 20, no. 3, pp. 195-200, 2017.
https://doi.org/10.1111/codi.13901
[15] O. Åkesson, I. Syk, G. Lindmark, and P. Buchwald, "Morbidity related to defunctioning loop ileostomy in low anterior resection," Int. J. Colorectal Dis., vol. 27, no. 12, pp. 1619-1623, 2012.
https://doi.org/10.1007/s00384-012-1490-y
[16] A. Tsunoda, Y. Tsunoda, K. Narita, M. Watanabe, K. Nakao, and M. Kusano, "Quality of life after low anterior resection and temporary loop ileostomy," Dis. Colon Rectum, vol. 51, no. 2, pp. 218-222, 2008.
https://doi.org/10.1007/s10350-007-9101-7
[17] "Validate User," Oup.com. [Online]. Available: https://academic.oup.com/bjs/article/92/9/1137/6144393?login=true. [Accessed: 11-Jul-2021].
[18] M. M. Nowakowski et al., "Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome," Wideochir. Inne Tech. Malo Inwazyjne, vol. 13, no. 3, pp. 306-314, 2018.
https://doi.org/10.5114/wiitm.2018.76913
[19] A. K. Danielsen et al., "Early closure of a temporary ileostomy in patients with rectal cancer: A multicenter randomized controlled trial," Ann. Surg., vol. 265, no. 2, pp. 284-290, 2017.
https://doi.org/10.1097/SLA.0000000000001829
[20] W. Sun et al., "Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and quality of life in rectal cancer: Post hoc analysis of a randomized controlled trial," Ann. Surg. Oncol., vol. 26, no. 3, pp. 746-755, 2019.
https://doi.org/10.1245/s10434-018-07096-8
[21] I. Vogel et al., "Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis," Tech. Coloproctol., vol. 25, no. 7, pp. 751-760, 2021.
https://doi.org/10.1007/s10151-021-02436-5
[22] E. L. Beamish, J. Johnson, E. J. Shaw, N. A. Scott, A. Bhowmick, and R. J. Rigby, "Loop ileostomy-mediated fecal stream diversion is associated with microbial dysbiosis," Gut Microbes, vol. 8, no. 5, pp. 467-478, 2017.
https://doi.org/10.1080/19490976.2017.1339003
[23] L. Lundby et al., "Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer," Dis. Colon Rectum, vol. 48, no. 7, pp. 1343-9; discussion 1349-52; author reply 1352, 2005.
https://doi.org/10.1007/s10350-005-0049-1
[24] B. Moran, S. Karandikar, and I. Geh, "Association of coloproctology of great Britain & Ireland (ACPGBI): Guidelines for the management of cancer of the colon, rectum and anus (2017) - introduction," Colorectal Dis., vol. 19 Suppl 1, pp. 6-8, 2017.
https://doi.org/10.1111/codi.13702
[25] S. Farag, S. Rehman, P. Sains, M. K. Baig, and M. S. Sajid, "Early vs delayed closure of loop defunctioning ileostomy in patients undergoing distal colorectal resections: an integrated systematic review and meta-analysis of published randomized controlled trials," Colorectal Dis., vol. 19, no. 12, pp. 1050-1057, 2017.
https://doi.org/10.1111/codi.13922
[26] P. G. Vaughan-Shaw et al., "Protocol for a multicentre, dual prospective and retrospective cohort study investigating timing of ileostomy closure after anterior resection for rectal cancer: The CLOSurE of Ileostomy Timing (CLOSE-IT) study," BMJ Open, vol. 8, no. 10, p. e023305, 2018.
https://doi.org/10.1136/bmjopen-2018-023305
[27] Y. J. Choi et al., "Clinical outcomes of ileostomy closure according to timing during adjuvant chemotherapy after rectal cancer surgery," Ann. Coloproctol., vol. 35, no. 4, pp. 187-193, 2019.
https://doi.org/10.3393/ac.2018.10.18.1
[28] H. Tulchinsky, E. Shacham-Shmueli, J. M. Klausner, M. Inbar, and R. Geva, "Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy?: Optimal Interval to Ileostomy Closure," J. Surg. Oncol., vol. 109, no. 3, pp. 266-269, 2014.
https://doi.org/10.1002/jso.23493
[29] G. Vrakas et al., "Defunctioning ileostomy closure following low anterior resection by chemotherapy," Tech. Coloproctol., vol. 14 Suppl 1, no. S1, pp. S77-8, 2010.
https://doi.org/10.1007/s10151-010-0628-6
[30] M. F. Sier, L. van Gelder, D. T. Ubbink, W. A. Bemelman, and R. J. Oostenbroek, "Factors affecting timing of closure and non-reversal of temporary ileostomies," Int. J. Colorectal Dis., vol. 30, no. 9, pp. 1185-1192, 2015.
https://doi.org/10.1007/s00384-015-2253-3
[31] G. G. David, J. P. Slavin, S. Willmott, D. J. Corless, A. U. Khan, and C. R. Selvasekar, "Loop ileostomy following anterior resection: is it really temporary?," Colorectal Dis., vol. 12, no. 5, pp. 428-432, 2010.
https://doi.org/10.1111/j.1463-1318.2009.01815.x
[32] R. Lindgren, O. Hallböök, J. Rutegård, R. Sjödahl, and P. Matthiessen, "What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial," Dis. Colon Rectum, vol. 54, no. 1, pp. 41-47, 2011.
https://doi.org/10.1007/DCR.0b013e3181fd2948
[33] F. Nuytens, D. Develtere, G. Sergeant, I. Parmentier, A. D'Hoore, and M. D'Hondt, "Perioperative radiotherapy is an independent risk factor for major LARS: a cross-sectional observational study," Int. J. Colorectal Dis., vol. 33, no. 8, pp. 1063-1069, 2018.
https://doi.org/10.1007/s00384-018-3043-5
[34] S. Haas et al., "Anal sphincter dysfunction in patients treated with primary radiotherapy for anal cancer: a study with the functional lumen imaging probe," Acta Oncol., vol. 57, no. 4, pp. 465-472, 2018.
https://doi.org/10.1080/0284186X.2018.1438658
[35] Colorectal Cancer Collaborative Group, "Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials," Lancet, vol. 358, no. 9290, pp. 1291-1304, 2001.
https://doi.org/10.1016/S0140-6736(01)06409-1
[36] R. M. Jiménez-Rodríguez et al., "Is the interval from surgery to ileostomy closure a risk factor for low anterior resection syndrome?," Colorectal Dis., vol. 19, no. 5, pp. 485-490, 2017.
https://doi.org/10.1111/codi.13524
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[1]
H. H. Kaka Ali, “The effect of ileostomy closure timing on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer”, KJAR, vol. 6, no. 1, pp. 126–134, Aug. 2021, doi: 10.24017/science.2021.1.13.
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06-08-2021
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