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Observational Study
. 2024 Dec 11;29(1):16.
doi: 10.1007/s10151-024-03047-6.

Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

F Ferrara  1 , G Rizzo  2 , A Bondurri  3 , C Forni  4 , G Anania  5 , A Anastasi  6 , G L Baiocchi  7 , L Boccia  8 , D Cassini  9 , M Catarci  10 , G Cestaro  11 , N Cillara  12 , F Cobellis  13 , R De Luca  14 , P De Nardi  15 , S Deidda  16 , D Delogu  17 , M Fedi  18 , M C Giuffrida  19 , U Grossi  20 , H Impellizzeri  21 , A Langone  22 , A Lauretta  23 , F Lo Celso  24 , A Maffioli  3 , M Manigrasso  25 , C Marafante  26 , L Marano  27 , P Marinello  28 , P Massucco  29 , D Merlini  30 , L Morelli  31 , M Mozzon  32 , D P Pafundi  33 , F Pata  34 , G Pellino  35 , R Peltrini  36 , A Petrina  37 , D Piazza  38 , C Rabuini  39 , A Resendiz  40 , B Salmaso  41 , M Santarelli  42 , G Sena  43 , L Siragusa  44 , N Tamini  45 , V Tondolo  2 , R Tutino  46 , A Vannelli  47 , M Veltri  18 , L Vincenti  48 , D Parini  41 ; MISSTO Snapshot Study Collaborative Group
Collaborators, Affiliations
Observational Study

Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

F Ferrara et al. Tech Coloproctol. .

Abstract

Background: Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses.

Methods: From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications.

Results: In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8% and 29.62%, respectively. The most frequent complications were dehydration (17.77%), peristomal skin dermatitis (13.59%), mucocutaneous separation (8.36%), and stoma retraction (4.18%). At the end of follow-up (median time 9 months), the overall stoma closure rate was 83.97% (241 patients), with a median time to stoma closure of 146 days (range 9-483 days). On multivariate analysis, the presence of a stoma nurse was a significant protective factor against stoma-related complications.

Conclusions: This study demonstrated that the creation of a protective ileostomy is associated to a nonnegligible rate of short-term and long-term postoperative stoma-related morbidity, higher than 25%. The most frequent complication is dehydration, and the presence of stoma-specialized nurses seems to be a protective factor for stoma-related complications. Moreover, more than 15% of protective stomas were not closed at the end of follow-up.

Keywords: Colorectal; Ileostomy; Ostomy; Rectal cancer.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflicts of interest Informed consent: Informed consent was obtained from all individual participants included in the study. Ethical approval: The study was approved by the Institutional Ethics Committee (IEC) of the coordinating center (Rovigo - Italy) and by all the IECs of the participating centers. The study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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