Early closure of ileostomy after rectal resection for cancer fails to provide better QoL

Switzerland: A recent study in the journal Diseases of the Colon & Rectum showed that early closure of ileostomy (at 2 weeks) does not provide a better quality of life (QoL) up to 4 months after low rectal resection for cancer. However, it is afflicted with significantly higher morbidity and adverse feasibility versus late closure. 

The creation of a diverting stoma is an accepted method for protecting low colorectal or coloanal anastomosis (LA) following rectal cancer surgery. Previous studies have shown a decrease of clinically relevant anastomotic leaks and the need for interventional or surgical revisions when a protective stoma was created. However, the presence of stoma may be a big burden for the patient, regardless of the positive effect on LA healing. Several studies have shown a negative effect on the patients' QoL. Therefore, the concept of early stoma closure (EC), that is, ≈2 weeks after rectal resection, has been proposed as an alternative to late stoma closure (LC) after 12 weeks. 

Several RCTs have reported promising results for the concept of EC after low anterior resection (LAR) in selected patients. Another study had to be terminated prematurely because of safety after EC. In the present prospective randomized controlled multicenter trial, Andreas T. Elsner, Department of Surgery, Hospital of Baselland–Liestal, Liestal, Switzerland, and colleagues aimed to evaluate this early time point of protective stoma closure after LAR with regard to patient QoL, general and intraoperative feasibility, and safety (morbidity and mortality) in comparison with LC.