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Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

BACKGROUND: Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patie...

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Autores principales: Keane, C., Park, J., Öberg, S., Wedin, A., Bock, D., O'Grady, G., Bissett, I., Rosenberg, J., Angenete, E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590150/
https://www.ncbi.nlm.nih.gov/pubmed/30706439
http://dx.doi.org/10.1002/bjs.11092
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author Keane, C.
Park, J.
Öberg, S.
Wedin, A.
Bock, D.
O'Grady, G.
Bissett, I.
Rosenberg, J.
Angenete, E.
author_facet Keane, C.
Park, J.
Öberg, S.
Wedin, A.
Bock, D.
O'Grady, G.
Bissett, I.
Rosenberg, J.
Angenete, E.
author_sort Keane, C.
collection PubMed
description BACKGROUND: Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patients who underwent early or late closure of an ileostomy after rectal resection for cancer. METHODS: Early closure (8–13 days) was compared with late closure (after 12 weeks) of the ileostomy following rectal cancer surgery in a multicentre RCT. Exclusion criteria were: signs of anastomotic leakage, diabetes mellitus, steroid treatment and postoperative complications. Bowel function was evaluated using the LARS score and the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI). RESULTS: Following index surgery, 112 participants were randomized (55 early closure, 57 late closure). Bowel function was evaluated at a median of 49 months after stoma closure. Eighty‐two of 93 eligible participants responded (12 had died and 7 had a permanent stoma). Rates of bowel dysfunction were higher in the late closure group, but this did not reach statistical significance (major LARS in 29 of 40 participants in late group and 25 of 42 in early group, P = 0·250; median BFI score 63 versus 71 respectively, P = 0·207). Participants in the late closure group had worse scores on the urgency/soiling subscale of the BFI (14 versus 17; P = 0·017). One participant in the early group and six in the late group had a permanent stoma (P = 0·054). CONCLUSION: Patients undergoing early stoma closure had fewer problems with soiling and fewer had a permanent stoma, although reduced LARS was not demonstrated in this cohort. Dedicated prospective studies are required to evaluate definitively the association between temporary ileostomy, LARS and timing of closure.
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spelling pubmed-65901502019-07-08 Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer Keane, C. Park, J. Öberg, S. Wedin, A. Bock, D. O'Grady, G. Bissett, I. Rosenberg, J. Angenete, E. Br J Surg Original Articles BACKGROUND: Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patients who underwent early or late closure of an ileostomy after rectal resection for cancer. METHODS: Early closure (8–13 days) was compared with late closure (after 12 weeks) of the ileostomy following rectal cancer surgery in a multicentre RCT. Exclusion criteria were: signs of anastomotic leakage, diabetes mellitus, steroid treatment and postoperative complications. Bowel function was evaluated using the LARS score and the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI). RESULTS: Following index surgery, 112 participants were randomized (55 early closure, 57 late closure). Bowel function was evaluated at a median of 49 months after stoma closure. Eighty‐two of 93 eligible participants responded (12 had died and 7 had a permanent stoma). Rates of bowel dysfunction were higher in the late closure group, but this did not reach statistical significance (major LARS in 29 of 40 participants in late group and 25 of 42 in early group, P = 0·250; median BFI score 63 versus 71 respectively, P = 0·207). Participants in the late closure group had worse scores on the urgency/soiling subscale of the BFI (14 versus 17; P = 0·017). One participant in the early group and six in the late group had a permanent stoma (P = 0·054). CONCLUSION: Patients undergoing early stoma closure had fewer problems with soiling and fewer had a permanent stoma, although reduced LARS was not demonstrated in this cohort. Dedicated prospective studies are required to evaluate definitively the association between temporary ileostomy, LARS and timing of closure. John Wiley & Sons, Ltd 2019-02-01 2019-04 /pmc/articles/PMC6590150/ /pubmed/30706439 http://dx.doi.org/10.1002/bjs.11092 Text en © 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Keane, C.
Park, J.
Öberg, S.
Wedin, A.
Bock, D.
O'Grady, G.
Bissett, I.
Rosenberg, J.
Angenete, E.
Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
title Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
title_full Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
title_fullStr Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
title_full_unstemmed Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
title_short Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
title_sort functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590150/
https://www.ncbi.nlm.nih.gov/pubmed/30706439
http://dx.doi.org/10.1002/bjs.11092
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