Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)
Authors: Rizzo Gianluca , Ferrara Francesco , Parini Dario , Pata Francesco , Forni Cristiana , Anania Gabriele , Anastasi Alessandro , Baiocchi Gian Luca , Boccia Luigi , Cassini Diletta , Catarci Marco , Cestaro Giovanni , Cillara Nicola , Cobellis Francesco , De Luca Raffaele , De Nardi Paola , Deidda Simona , Delogu Daniele , Fedi Massimo , Giuffrida Maria Carmela , Grossi Ugo , Impellizzeri Harmony , Langone Antonio , Lauretta Andrea , Lo Celso Francesca , Maffioli Anna , Manigrasso Michele , Marafante Chiara , Marano Luigi , Marinello Peter , Massucco Paolo , Merlini David , Morelli Luca , Mozzon Marta , Pafundi Donato Paolo , Pellino Gianluca , Peltrini Roberto , Petrina Adolfo , Piazza Diego , Rabuini Claudio , Resendiz Aridai , Salmaso Beatrice , Santarelli Mauro , Sena Giuseppe , Siragusa Leandro , Tamini Nicolò , Tondolo Vincenzo , Tutino Roberta , Vannelli Alberto , Veltri Marco , Vincenti Leonardo , Bondurri Andrea ,   MISSTO Snapshot Study Collaborative Group, Bagolini Francesco , Chiozza Matteo , Pedon Sabrina , Canonico Giuseppe , Di Martino Carmela , Adinolfi Elvira , Mastronardi Manuela , Petrella Massimo , Mantovani Guido , Pascariello Annalisa , Baldazzi Gianandrea , Spalluto Marta , Della Sanità Marco , Mattei Maria Sole , Benedetti Michele , Montemurro Leonardo , Bottini Corrado , Grillone Gianluca , Deserra Antonello , Cannavera Alessandro , Cobellis Luigi , Scola Roberto , Savastano Francesca , Carbone Gabriele , Denti Francesco , Zorcolo Luigi , Restivo Angelo , Ippolito Luca , Scognamillo Fabrizio , Marrosu Antonio Giulio , Giannessi Sandro , Robustelli Virna , Stella Marco , Gelarda Enrico , Donati Danilo , Sasia Diego , Piccino Marco , Brun Peressut Alberto , Baldan Rino , Mihail Creciun , Vitali Alessandro , Moretto Gianluigi , Galleano Raffaele , Ghazouani Omar , Pollesel Sara , Belluco Claudio , De Manzini Nicolò , Porcelli Fabio , Gabrieli Alice , Micalef Andrea , Zaffaroni Gloria , Milone Marco , De Palma Giovanni Domenico , Vertaldi Sara , Apostu Ana Lavinia , Birolo Simone Lorenzo , Garino Mauro , Roviello Franco , Marrelli Daniele , Carbone Ludovico , Bertelli Giacomo , Frena Antonio , Gonella Federica , Palisi Marco , Marin Federico , Di Franco Gregorio , Furbetta Niccolò , Comandatore Annalisa , Folliero Cristina , Amodio Luca , Menegon Tasselli Francesco , D’Ambrosio Marco , Selvaggi Francesco , Iacone Biancamaria , Bracale Umberto , Ciaccarini Roberto , Boncompagni Michela , Mascali Davide , Piazza Caterina , Falzone Enrico , Reddavid Rossella , Degiuli Maurizio , De Luca Maurizio , Visconti Diego , Ferguglia Alice , Piceni Chiara , Ammerata Giorgio , Sica Giuseppe , Guida Andrea Martina , Sensi Bruno , Ripamonti Lorenzo , De Carlo Giulia , Venturelli Paolina , Cocorullo Gianfranco , Della Valle Ada , Romanzi Andrea , Milanesi Maria , Tomasicchio Giovanni , Paradiso Nicola , Verriello Ilaria 
Published: February 2025

Abstract

Purpose
Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure.

Methods
Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications.

Results
A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications.

Conclusion
This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care.