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Loop-ileostomy reversal-patient-related characteristics influencing time to closure.

Abstract：

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.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Gustafsson CP,Gunnarsson U,Dahlstrand U,Lindforss U

doi

10.1007/s00384-018-2994-x

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

593-600

issue

5

eissn

0179-1958

issn

1432-1262

pii

10.1007/s00384-018-2994-x

journal_volume

33

pub_type

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