Risk factors for non-closure of diverting loop ileostomy after rectal cancer surgery: a multicenter prospective study conducted by the Clinical Study Group of Osaka University, Colorectal Group

Abstract Background Diverting loop ileostomy is commonly used to mitigate the consequences of anastomotic leakage after rectal cancer surgery. However, some patients do not undergo stoma closure, resulting in a permanent stoma that may impair quality of life. This study evaluated the closure rate, reasons for non-closure, and associated preoperative factors using multicenter prospective data. Methods This study was a subanalysis of a multicenter prospective study conducted at 24 institutions. Patients with rectal adenocarcinoma who underwent laparoscopic or robotic low anterior resection or intersphincteric resection with planned diverting loop ileostomy between July 2015 and April 2021 were included. Stomas not closed within 1 year were classified as non-closed. Preoperative characteristics were compared between the stoma closure and non-closure groups using univariable analyses. Results Among 320 patients, 298 (93.1%) underwent stoma closure, whereas 22 (6.9%) did not. Reasons for non-closure were postoperative complications ( n = 9), cancer recurrence ( n = 6), patient preference ( n = 5), and death ( n = 2). In univariable comparisons, patients with stoma non-closure more frequently had ASA-PS ≥2 (86.4% vs. 63.8%, P = 0.036), stage III–IV disease (68.2% vs. 38.9%, P = 0.012), and serum albumin <3.5 g/dL (31.8% vs. 7.4%, P = 0.002) than those who underwent stoma closure. Conclusions Although most diverting loop ileostomies were successfully closed, 6.9% were not reversed. Patients with stoma non-closure more frequently had ASA-PS ≥2, advanced clinical stage, and low serum albumin levels than those who underwent stoma closure. These findings may be useful for preoperative counseling. Trial registration UMIN000038150.