The effect of the timing of the elimination of preventive ileostomy on the incidence of severe low anterior resection syndrome

AIM: to study the effect of early ileostomy closure on the incidence of low anterior resection syndrome (LARS) in patients with rectal cancer.

PATIENTS AND METHODS: one-hundred patients with rectal cancer underwent radiation therapy with a total focal dose of 50-54 Gy with radiomodification with capecitabine and low anterior rectal resection with preventive ileostomy. The primary endpoint of the study was the incidence of significant anorectal dysfunction at 3 months after ileostomy closure. Secondary endpoints included the incidence and severity of clinical manifestations of anorectal dysfunction, anal incontinence score according to the Wexner scale, overall distribution of anorectal dysfunction (absent, mild, severe) and the incidence of postoperative complications. Patients were randomized into two groups: with early ileostomy closure within 6 (5; 7) weeks after low anterior rectal resection (50 patients) and with late ileostomy closure after 24.5 (20; 29) weeks (50 patients). Three months after ileostomy closure, a questionnaire was done using the LARS and Wexner scales.

RESULTS OF THE STUDY: the results obtained at 3 months after ileostomy closure showed advantages of the early ileostomy closure group. According to the GIFO scale, clinical manifestations of anorectal dysfunction were significantly less common in this group (p < 0.05). According to the LARS scale, the incidence of anorectal dysfunction in the early ileostomy closure group was 40%, while in the late closure group it was 70% (OR (odds ratio) = 3.50; 95% CI (confidence interval): 1.49–8.23; p = 0.0046). Moreover, severe LARS was detected in 6% and 26% of patients, respectively (OR = 0.12; 95% CI: 0.03–0.43; p = 0.012). The Wexner scale score was also significantly better in the early closure group (5 (4; 8) points) compared to the late closure group (9 (8; 10) points, p < 0.0001). With regard to the complications that developed in the late ileostomy closure group, a significantly higher incidence of colitis was noted (21/50 (42%) versus 6/50 (12%) cases, p = 0.0014).

CONCLUSION: in the course of the conducted work it was established that 3 months after ileostomy closure, patients in the early closure group showed less manifestations of anorectal dysfunction compared to patients in the late closure group.

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