We always enjoy chatting with you when we are out and about at meetings and conferences. One of the themes of conversation we have noticed during this year is how much longer patients are waiting, post pandemic, for stoma reversal following low anterior resection (LAR) for rectal cancer.
Typically, patients have a defunctioning stoma for 3 to 6 months, but now, it’s not uncommon for this period to exceed 12 months or longer. So, any adverse effects of having an ileostomy on the patient’s physical, psychological, and social well-being are potentially worsened. We wondered if this might also have an impact on bowel function.
Vogel et al (2021) explored the impact of a defunctioning ileostomy, and time to ileostomy closure on bowel function after LAR for rectal cancer. Through a systematic review and meta-analysis, they identified 11 studies (1400 patients), that reported on functional outcome after LAR with at least 1 year follow-up, except for one study. In seven studies, major low anterior resection syndrome (LARS) occurred more often in the ileostomy group and presence of an ileostomy consistently predicted poorer bowel function following stoma reversal.
Six studies examined the impact of ileostomy reversal timing on LARS score. Closure within 6 months after the initial surgery reduced the risk of major LARS, while reversal after 1 year was associated with a higher risk of major LARS. Four additional studies suggested an increased risk of major LARS with a longer time to ileostomy closure, although the difference was not statistically significant.
This review suggests that a defunctioning ileostomy increases risk of developing major LARS. Also, a prolonged time to ileostomy reversal seems to reinforce the negative effect on bowel function. They recommend that early reversal should be an important part of the patient pathway.
Achieving early reversal in the current climate may prove difficult for a myriad of reasons. This paper raises awareness on the specific patient groups at a heightened risk of developing LARS. With extended reversal times, an increasing number of our patients might find themselves grappling with LARS symptoms. Therefore, it serves as a timely prompt to take a proactive approach and initiate discussions with patients regarding their bowel function. Such conversations provide an avenue for addressing the impact of symptoms on their quality of life and, ultimately, offering them access to effective treatments.
Vogel I, Reeves N, Tanis PJ, Bemelman WA, Torkington J, Hompes R, Cornish JA. Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol. 2021 Jul;25(7):751-760. doi: 10.1007/s10151-021-02436-5. Epub 2021 Apr 1. PMID: 33792822; PMCID: PMC8187190.
Available on Open Access: https://pubmed.ncbi.nlm.nih.gov/33792822/