Clinical Outcomes of Ileostomy Closure According to Timing During Adjuvant Chemotherapy After Rectal Cancer Surgery

Abstract

Purpose: No guidelines exist detailing when to implement a temporary ileostomy closure in the setting of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer. The aim of this study was to evaluate the clinical and oncological outcomes of ileostomy closure during adjuvant chemotherapy in patients with curative resection of rectal cancer.

Methods: This retrospective study investigated 220 patients with rectal cancer undergoing sphincter-saving surgery with protective loop ileostomy from January 2007 to August 2016. Patients were divided into 2 groups: group 1 (n = 161) who underwent stoma closure during adjuvant chemotherapy and group 2 (n = 59) who underwent stoma closure after adjuvant chemotherapy.

Results: No significant differences were observed in operative time, blood loss, postoperative hospital stay, or postoperative complications in ileostomy closure between the 2 groups. No difference in overall survival (P = 0.959) or disease-free survival (P = 0.114) was observed between the 2 groups.

Conclusion: Ileostomy closure during adjuvant chemotherapy was clinically safe, and interruption of chemotherapy due to ileostomy closure did not change oncologic outcomes.

Keywords: Adjuvant chemotherapy; Ileostomy; Rectal neoplasms.

Fig. 1.

Case selection diagram showing inclusion and exclusion criteria. ^aTotal number of excluded patients is not equal to the sum of patients for each exclusion criterion.

Fig. 2.

Survival analysis between the 2 groups: (A) overall survival in all patients, (B) disease-free survival in all patients, (C) overall survival in patients with ypStage II, (D) disease-free survival in patients with ypStage II, (E) overall survival in patients with ypStage III, and (F) disease-free survival in patients with ypStage III.