Effect and influencing factors of early ileostomy closure 2-4 weeks on patients with rectal cancer.

BACKGROUND

Early ileostomy closure(EIC) should be performed in selected patients. However, the optimal timing for EIC and which specific patients could benefit from it remains controversial. The aim of the study was to explore the safety and effect of 2-4 weeks ileostomy closure and influencing factors.

METHODS

This multicenter retrospective study conducted at three hospitals in China included 428 patients with underwent laparoscopic radical resection for rectal cancer followed by protective loop ileostomy. According to the time of ileostomy closure, the patients were divided into early closure (EC;2-4 weeks after operation) and routine closure(RC; 3-6 months after operation). A multivariate logistic regression model was used to analyze independent risk factors for EIC. A one-to-one propensity score matching (PSM) analysis was performed to balance baseline differences between groups. Primary endpoint was post-ileostomy closure complications. Secondary endpoints were stoma-related complications, perioperative outcomes, anal function and quality of life with the 36-item Short Form Health Survey(SF-36).

RESULTS

A total of 428 patients were included, with 94 receiving EC and 334 receiving RC. Multivariate logistic regression analysis screened out age, tumor site, neoadjuvant chemoradiotherapy, and pathological tumor-node-metastasis (pTNM) stage as independent influencing factors for EIC. The Nomogram was established based on these four factors. The area under the curve (AUC) of the model was 0.756 (95%CI: 0.70-0.811). The decision curve analysis (DCA) also showed good clinical practicality. After PSM, 89 pairs were matched. There was no significant difference between two groups regarding the post-ileostomy closure complications and anal function. EC group had significantly lower stoma-related complications(P < 0.05), shorter operative time (P < 0.05) and higher SF-36 quality of life score (P < 0.001) compared to RC group.

CONCLUSION

Early closure of ileostomy at 2-4 weeks is safe and feasible in selected patients. The Nomogram prediction model that incorporates age, tumor site, neoadjuvant chemoradiotherapy and pTNM stage can effectively predict EIC in rectal cancer, and can perform effective preoperative stratification to guide clinical decision-making and personalized treatment.