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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2014

01-02-2014 | Colorectal Cancer

Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer

Authors: Uma R. Phatak, MD, Lillian S. Kao, MD, MS, Y. Nancy You, MD, MHSc, Miguel A. Rodriguez-Bigas, MD, John M. Skibber, MD, Barry W. Feig, MD, Sa Nguyen, MS, Scott B. Cantor, PhD, George J. Chang, MD, MS, FACS, FASCRS

Published in: Annals of Surgical Oncology | Issue 2/2014

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Abstract

Background

Radical resection is the primary treatment for rectal cancer. When anastomosis is possible, a temporary ileostomy is used to decrease morbidity from a poorly healed anastomosis. However, ileostomies are associated with complications, dehydration, and need for a second operation. We sought to evaluate the impact of ileostomy-related complications on the treatment of rectal cancer.

Methods

We conducted a retrospective study of patients who underwent sphincter-preserving surgery between January 2005 and December 2010 at a tertiary cancer center. The primary outcome was the overall rate of ileostomy-related complications. Secondary outcomes included complications related to ileostomy status, ileostomy closure, anastomotic complications at primary resection, rate of stoma closure, and completion of adjuvant chemotherapy assessed by multivariate logistic regression.

Results

Of 294 patients analyzed, 32 % (n = 95) were women. Two hundred seventy-one (92 %) received neoadjuvant chemoradiation. The median tumor distance from the anal verge was 7 cm (interquartile range 5–10 cm). Two hundred eighty-one (96 %) underwent stoma closure at a median of 7 months (interquartile range 5.4–8.3 months). The most common complication related to readmission was dehydration (n = 32–11 %). Readmission within 60 days of primary resection was associated with delay in initiating adjuvant chemotherapy (odds ratio 3.01, 95 % confidence interval 1.42–6.38, p = 0.004).

Conclusions

Diverting ileostomies created during surgical treatment of rectal cancers are associated with morbidity; however, this is balanced against the risk of anastomosis-related morbidity at rectal resection. Given the potential benefit of fecal diversion, patient-oriented interventions to improve ostomy management, particularly during adjuvant chemotherapy, can be expected to yield marked benefits.
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Metadata
Title
Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer
Authors
Uma R. Phatak, MD
Lillian S. Kao, MD, MS
Y. Nancy You, MD, MHSc
Miguel A. Rodriguez-Bigas, MD
John M. Skibber, MD
Barry W. Feig, MD
Sa Nguyen, MS
Scott B. Cantor, PhD
George J. Chang, MD, MS, FACS, FASCRS
Publication date
01-02-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 2/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3287-9

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