BACKGROUND AND OBJECTIVES: A significant proportion of patients undergoing rectal cancer surgery receive a temporary ileostomy because of its benefits in case of anastomotic dehiscence. However, the best timing for closure remains unclear. METHODS: Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared in a single-center randomized controlled trial conducted at National Cancer Institute (Vilnius, Lithuania). Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other serious complications were randomized to early or standard ileostomy closure groups. Thirty days postoperative morbidity following ileostomy closure was the primary outcome of the study. RESULTS: The trial was prematurely terminated due to the safety reason after 86 patients were randomized to EC (43 patients) and SC (43 patients) groups. The overall 30 days postoperative morbidity rate was dramatically higher in the EC group (27.9% vs 7.9%; P = 0.024). Moreover, severe complications (Clavien-Dindo ≥3) were present only after EC of ileostomy in five (11.6%) patients. CONCULSION: Early closure of ileostomy at 30 days after radical rectal resection is not safe and should not be performed.
BACKGROUND AND OBJECTIVES: A significant proportion of patients undergoing rectal cancer surgery receive a temporary ileostomy because of its benefits in case of anastomotic dehiscence. However, the best timing for closure remains unclear. METHODS: Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared in a single-center randomized controlled trial conducted at National Cancer Institute (Vilnius, Lithuania). Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other serious complications were randomized to early or standard ileostomy closure groups. Thirty days postoperative morbidity following ileostomy closure was the primary outcome of the study. RESULTS: The trial was prematurely terminated due to the safety reason after 86 patients were randomized to EC (43 patients) and SC (43 patients) groups. The overall 30 days postoperative morbidity rate was dramatically higher in the EC group (27.9% vs 7.9%; P = 0.024). Moreover, severe complications (Clavien-Dindo ≥3) were present only after EC of ileostomy in five (11.6%) patients. CONCULSION: Early closure of ileostomy at 30 days after radical rectal resection is not safe and should not be performed.
Authors: Fateme Rajabiyazdi; Marylise Boutros; Natasha G Caminsky; Jeongyoon Moon; Nancy Morin; Karim Alavi; Rebecca C Auer; Liliana G Bordeianou; Sami A Chadi; Sébastien Drolet; Amandeep Ghuman; Alexander Sender Liberman; Tony MacLean; Ian M Paquette; Jason Park; Sunil Patel; Scott R Steele; Patricia Sylla; Steven D Wexner; Carol-Ann Vasilevsky Journal: Surg Endosc Date: 2022-10-04 Impact factor: 3.453
Authors: Mauro Podda; Patricia Sylla; Gianluca Baiocchi; Michel Adamina; Vanni Agnoletti; Ferdinando Agresta; Luca Ansaloni; Alberto Arezzo; Nicola Avenia; Walter Biffl; Antonio Biondi; Simona Bui; Fabio C Campanile; Paolo Carcoforo; Claudia Commisso; Antonio Crucitti; Nicola De'Angelis; Gian Luigi De'Angelis; Massimo De Filippo; Belinda De Simone; Salomone Di Saverio; Giorgio Ercolani; Gustavo P Fraga; Francesco Gabrielli; Federica Gaiani; Mario Guerrieri; Angelo Guttadauro; Yoram Kluger; Ari K Leppaniemi; Andrea Loffredo; Tiziana Meschi; Ernest E Moore; Monica Ortenzi; Francesco Pata; Dario Parini; Adolfo Pisanu; Gilberto Poggioli; Andrea Polistena; Alessandro Puzziello; Fabio Rondelli; Massimo Sartelli; Neil Smart; Michael E Sugrue; Patricia Tejedor; Marco Vacante; Federico Coccolini; Justin Davies; Fausto Catena Journal: World J Emerg Surg Date: 2021-07-02 Impact factor: 5.469
Authors: Marcin Zeman; Marek Czarnecki; Andrzej Chmielarz; Adam Idasiak; Maciej Grajek; Agnieszka Czarniecka Journal: World J Surg Oncol Date: 2020-08-14 Impact factor: 2.754