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Observational Study
. 2025 Feb 18;40(1):43.
doi: 10.1007/s00384-025-04827-8.

Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

Gianluca Rizzo  1 , Francesco Ferrara  2 , Dario Parini  3 , Francesco Pata  4 , Cristiana Forni  5 , Gabriele Anania  6 , Alessandro Anastasi  7 , Gian Luca Baiocchi  8 , Luigi Boccia  9 , Diletta Cassini  10 , Marco Catarci  11 , Giovanni Cestaro  12 , Nicola Cillara  13 , Francesco Cobellis  14 , Raffaele De Luca  15 , Paola De Nardi  16 , Simona Deidda  17 , Daniele Delogu  18 , Massimo Fedi  19 , Maria Carmela Giuffrida  20 , Ugo Grossi  21 , Harmony Impellizzeri  22 , Antonio Langone  23 , Andrea Lauretta  24 , Francesca Lo Celso  25 , Anna Maffioli  26 , Michele Manigrasso  27 , Chiara Marafante  28 , Luigi Marano  29 , Peter Marinello  30 , Paolo Massucco  31 , David Merlini  32 , Luca Morelli  33 , Marta Mozzon  34 , Donato Paolo Pafundi  35 , Gianluca Pellino  36 , Roberto Peltrini  37 , Adolfo Petrina  38 , Diego Piazza  39 , Claudio Rabuini  40 , Aridai Resendiz  41 , Beatrice Salmaso  3 , Mauro Santarelli  42 , Giuseppe Sena  43 , Leandro Siragusa  44 , Nicolò Tamini  45 , Vincenzo Tondolo  1 , Roberta Tutino  42 , Alberto Vannelli  46 , Marco Veltri  19 , Leonardo Vincenti  47 , Andrea Bondurri  26 ; MISSTO Snapshot Study Collaborative Group
Collaborators, Affiliations
Observational Study

Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

Gianluca Rizzo et al. Int J Colorectal Dis. .

Abstract

Purpose: Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure.

Methods: Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications.

Results: A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications.

Conclusion: This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care.

Keywords: Colorectal cancer; Ileostomy; Ostomy; Stoma; Surgery.

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Conflict of interest statement

Declarations. Ethics 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. Competing interests: Gianluca Pellino and Francesco Pata are editors on this journal, but are recused from the Editorial peer review process of this article. None of the other authors has a conflict of interest to declare.

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