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.