- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Early closure of ileostomy after rectal resection for cancer fails to provide better QoL
![Early closure of ileostomy after rectal resection for cancer fails to provide better QoL Early closure of ileostomy after rectal resection for cancer fails to provide better QoL](https://medicaldialogues.in/h-upload/2021/11/29/750x450_165087-rectal-resection.webp)
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.
The study, conducted at 3 Swiss hospitals, included 2 parallel groups. It included patients undergoing low anterior resection and temporary ileostomy for cancer. Patients were randomly allocated to early or late stoma closure. Before closure, colonic anastomosis was examined for integrity.
The primary efficacy outcome was the Gastrointestinal Quality of Life Index 6 weeks after resection.
Owing to safety concerns, the trial was stopped after 71 patients were randomly assigned to early closure (37 patients) or late closure (34 patients).
Following were the study's key findings:
- There were comparable baseline data between the groups. No difference in quality of life occurred 6 weeks (mean Gastrointestinal Quality of Life Index: 99.8 vs 106.0) and 4 months (108.6 vs 107.1) after index surgery.
- Intraoperative tendency of oozing (visual analog scale: 35.8 vs 19.3), adhesions (visual analog scale: 61.3 vs 46.2), leak of colonic anastomosis (19% vs 0%), leak of colonic or ileal anastomosis (24% vs 0%), and reintervention (16% vs 0%) were significantly higher after early closure.
- The concept of early closure failed in 10 patients (27% vs 0% in the late closure group).
"Our findings showed that early stoma closure does not provide better quality of life up to 4 months after low anterior resection but is afflicted with significantly adverse feasibility and higher morbidity when compared with late closure," the authors concluded.
Reference:
Elsner, Andreas T. M.D.1,2; Brosi, Philippe M.D.1,3; Walensi, Mikolaj M.D.1,4; Uhlmann, Michael M.D.1,5; Egger, Bernhard M.D.6; Glaser, Christine M.D.1,7; Maurer, Christoph A. M.D.1,3 Closure of Temporary Ileostomy 2 Versus 12 Weeks After Rectal Resection for Cancer, Diseases of the Colon & Rectum: November 2021 - Volume 64 - Issue 11 - p 1398-1406 doi: 10.1097/DCR.0000000000002182
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751