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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

Funded in part through an American Society of Colon and Rectal Surgeons Research Foundation Resident Initiation Grant (URP) and National Cancer Institute Research K07-CA133187 (GJC) and Core Grants CA16672 (MDACC).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of General Surgery, The University of Texas Health Science Center, Houston, TX, USA

    Uma R. Phatak MD & Lillian S. Kao MD, MS

  2. Center for Surgical Trials and Evidence-Based Practice, The University of Texas Health Science Center, Houston, TX, USA

    Uma R. Phatak MD & Lillian S. Kao MD, MS

  3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Y. Nancy You MD, MHSc, Miguel A. Rodriguez-Bigas MD, John M. Skibber MD, Barry W. Feig MD, Sa Nguyen MS & George J. Chang MD, MS, FACS, FASCRS

  4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Scott B. Cantor PhD

Authors
  1. Uma R. Phatak MD
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  2. Lillian S. Kao MD, MS
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  3. Y. Nancy You MD, MHSc
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  4. Miguel A. Rodriguez-Bigas MD
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  5. John M. Skibber MD
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  6. Barry W. Feig MD
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  7. Sa Nguyen MS
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  8. Scott B. Cantor PhD
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  9. George J. Chang MD, MS, FACS, FASCRS
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Corresponding author

Correspondence to George J. Chang MD, MS, FACS, FASCRS.

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Phatak, U.R., Kao, L.S., You, Y.N. et al. Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer. Ann Surg Oncol 21, 507–512 (2014). https://doi.org/10.1245/s10434-013-3287-9

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  • DOI: https://doi.org/10.1245/s10434-013-3287-9

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