Colorectal Research Center, Department of Colorectal Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Asian J Surg. 2023 Oct;46(10):4277-4282. doi: 10.1016/j.asjsur.2023.01.099. Epub 2023 Feb 14.
Protective loop ileostomy is performed following low anterior resection (LAR) in patients with rectal cancer to reduce the complications of primary anastomosis. The optimal timing for ileostomy closure remains controversial. The aim of the current study was to compare the effects of early (<2 weeks) versus late (≥2 months) closure of the stoma in patients with rectal cancer undergoing LAR on surgical outcome and complications rates.
This prospective cohort study was conducted in two referral centers in Shiraz, Iran, during a 2-year period. We have consecutively and prospectively included adult patients with rectal adenocarcinoma who underwent LAR followed by protective loop ileostomy in our center during the study period. The baseline, tumor characteristics and complication as well as outcome was recorded in a 1-year follow-up and was compared between early and late ileostomy closure.
Overall, 69 patients (32 in early and 37 in late group) were included. The mean age of the patients was 59.40 ± 9.30 years and there were 46 (66.7%) men and 23 (33.3%) women. Patients undergoing early closure of the ileostomy had significantly shorter operation duration (p<0.001) and lower intraoperative bleeding (p<0.001) compared to late ileostomy closure. There was no significant difference between two study groups regarding the complications. Early closure was also not found to be a predictive factor of post-ileostomy closure complications.
Early closure (<2 weeks) of ileostomy after LAR in patients with rectal adenocarcinoma is a safe and feasible technique which is associated with favorable outcome.
在直肠肿瘤患者行低位前切除术（LAR）后进行保护性套叠回肠造口术，以降低初次吻合口并发症的发生率。回肠造口关闭的最佳时机仍存在争议。本研究旨在比较 LAR 术后行保护性套叠回肠造口的直肠肿瘤患者早期（<2 周）与晚期（≥2 个月）关闭造口对手术结果和并发症发生率的影响。
这是一项在伊朗设拉子的两个转诊中心进行的前瞻性队列研究，为期 2 年。我们连续前瞻性地纳入了在研究期间在我们中心行 LAR 加保护性套叠回肠造口术的直肠腺癌成年患者。在 1 年的随访中记录基线、肿瘤特征和并发症以及结果，并比较早期和晚期回肠造口关闭。
共有 69 例患者（早期 32 例，晚期 37 例）纳入本研究。患者的平均年龄为 59.40±9.30 岁，其中 46 例（66.7%）为男性，23 例（33.3%）为女性。与晚期回肠造口关闭相比，早期关闭回肠造口的患者手术时间明显缩短（p<0.001），术中出血量也明显减少（p<0.001）。两组患者的并发症无显著差异。早期关闭也不是回肠造口关闭后并发症的预测因素。
在直肠腺癌患者中，LAR 后早期（<2 周）关闭回肠造口是一种安全可行的技术，可获得良好的结果。
