Early closure of a temporary ileostomy after rectal resection for cancer

Abstract

A temporary ileostomy may reduce symptoms of anastomotic leakage after rectal resection for cancer. However, the stoma itself is associated with morbidity and early closure may reduce these symptoms. The aim of this thesis, based on a multicentre randomized controlled trial (EASY trial), was to evaluate early closure (8-13 days) of a temporary ileostomy compared to late closure (>12 weeks), after rectal resection for cancer. Endpoints were complications, quality of life, healthcare costs and bowel function. The trial included 55 patients in the early closure group, and 57 patients in the late closure group. Paper I evaluated number of postoperative complications up to 12 months following rectal resection. We found significantly fewer complications in the early closure group. Severe complications were uncommon in both groups. Paper II included assessment of patient reported quality of life, by validated questionnaires at 3, 6 and 12 months. There were no significant differences between the two groups. Paper III comprised a cost analysis, comparing direct costs from a healthcare perspective. Early closure was found to be significantly less costly at evaluation 12 months after surgery. Paper IV was a cross-sectional study performed at median 4 years after rectal resection, comparing patient reported bowel function. The late closure group reported more problems with urgency, compared with the early closure group. There was no difference in prevalence of low anterior resection syndrome. Overall, in selected patients without signs of postoperative complications, early closure of a temporary ileostomy after rectal resection for cancer was found to be safe and clinically advantageous in a randomized trial setting.