What factors can influence ileostomy closure time after colorectal surgery?

This study evaluated reasons for a delay to ileostomy closure in patients who underwent anterior resection for rectal cancer. This study showed that factors such as having chemotherapy or cancer progression may delay ileostomy closure.

The go-to surgical treatment for cancer of the middle and lower rectum involves removal of a significant length of the bowel, reducing the chances of the cancer returning. After surgery, many patients receive an ileostomy bag. An ileostomy is an opening in the belly where a part of the large intestine is brought. A small bag is attached to this opening where waste products are collected. An ileostomy is usually temporary, for a few months, so the intestine can rest after surgery. 

Studies have shown how a delay to the closure of ileostomy after rectal cancer surgery is associated with a greater risk of developing low anterior resection syndrome (LARS). Symptoms of LARS include inability to control bowel movements and passing small amounts of stool frequently. This lowers the quality of life (QoL) of patients.

In mainland EU and the USA, ileostomy closure time is around 4 months. In the UK, 34% of ileostomies have not been closed at 18 months. A wide range of factors causes a delay in closure. However, these factors have not been studied.

There were 2 studies that took place. Study 1 examined the medical records from 788 patients who had rectal cancer surgery and ileostomy formation. Study 2 followed 288 patients who were undergoing closure of ileostomies after having surgery for rectal cancer. Time to ileostomy closure and factors that influence this time were evaluated in both studies.

In study 1, ileostomy closure happened for 669 patients on an average of 259 days (around 8 months) after surgery. Ileostomies that did not close or had a delay to closure were 3.65 times more common in patients who had fluid leaking from the point where the intestines were re-connected following removal of the tumor. Patients who had cancer worsening were 2.05 times more likely to not have their ileostomy close. Also, having additional therapy after surgery was associated with a 2.62 times higher risk of not having an ileostomy closure. 

In study 2, ileostomy closure took an average of 271 days after surgery. Patients booked for ileostomy closure straight after surgery or additional therapy had an estimated 168-day shorter interval to closure. The need for chemotherapy after surgery and cancer worsening was associated with a delay in closure.

This study found that fluid leak, cancer worsening, and needing additional chemotherapy after surgery can delay ileostomy closure after rectal cancer surgery.

This study analyzed data from a few medical centers in the UK. Therefore, the results may not apply globally.