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Loop-ileostomy reversal: patient-related characteristics influencing time to closure
Department of Surgery, Visby Hospital, Gotland, Sweden.. (Clister)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. (Clister)
Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.. (Clister)
Department of Molecular Medicine and Surgery, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Solna, Sweden.. (Clister)
2018 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 33, no 5, p. 593-600Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To identify factors associated with timing of stoma reversal after rectal cancer surgery in a large Swedish register-based cohort.

METHODS: Three thousand five hundred sixty-four patients with rectal cancer who received a protective stoma during surgery in 2007-2013 were identified in the Swedish colorectal cancer register. Time to stoma reversal was evaluated over a follow-up period of one and a half years. Factors associated with timing of stoma reversal were analysed using Cox regression analysis. Reversal within 9 months (12 months if adjuvant chemotherapy) was considered latest expected time to closure.

RESULTS: Stoma reversal was performed in 2954 (82.9%) patients during follow-up. Patients with post-secondary education had an increased chance for early stoma reversal (HR 1.13; 95% CI 1.02-1.25). Postoperative complications (0.67; 0.62-0.73), adjuvant chemotherapy (0.63; 0.57-0.69), more advanced cancer stage (stage III 0.74; 0.66-0.83 and stage IV 0.38; 0.32-0.46) and higher ASA score (0.80; 0.71-0.90 for ASA 3-4) were associated with longer time to reversal. Two thousand four hundred thirty-seven (68.4%) patients had stoma reversal within latest expected time to closure. Factors associated to decreased chance of timely reversal were more advanced cancer stage (stage III 0.64; 0.50-0.81 and stage IV 0.19; 0.13-0.27), postoperative complications (0.50; 0.42-0.59) and higher ASA score (0.77; 0.61-0.96 for ASA 3-4).

CONCLUSIONS: Patients with a high level of education had a higher chance of timely reversal but medical factors had a stronger association to time to reversal. Patients with advanced rectal cancer are at high risk for non-reversal and should be considered for permanent stoma.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 33, no 5, p. 593-600
Keywords [en]
Defunctioning stoma, Loop-ileostomy, Low anterior resection, Reversal, Socioeconomic factors
National Category
Surgery Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:umu:diva-145535DOI: 10.1007/s00384-018-2994-xISI: 000430005000011PubMedID: 29508050OAI: oai:DiVA.org:umu-145535DiVA, id: diva2:1189018
Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2018-06-09Bibliographically approved

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