Predictors for complications after loop stoma closure in patients with rectal cancer

This unmatched case control study was undertaken to evaluate factors contributing to surgery-related complications of loop stoma closure in patients with rectal cancer.

Cases were consecutive patients with complications identified from a local registry. Complications were defined as surgery-related and included 30 days overall mortality. Controls were all other patients with stoma closure from the same population of the registry without the endpoint.

Of the 243 patients, 47 (19%) patients experienced a surgery-related complication, including 5 patients who died within 30 days after surgery. Significant risk factors in the univariate analysis were supervised operation (odds ratio 0.50; 95% confidence interval 0.27-0.95; P=0.04), stapled anastomosis (odds ratio 0.40; 95% confidence interval 0.17-0.91; P=0.04) and using a soft silicone drain (odds ratio 2.03; 95% confidence interval 1.07-3.85; P=0.04). Using a soft silicone drain (odds ratio 2.17; 95% confidence interval 1.10-4.26; P=0.03) and stapled anastomosis (odds ratio 0.38; 95% confidence interval 0.15-0.98; P=0.04) were the only significant predictors in the multivariate analysis.

The present study in a homogeneous group of patients with rectal cancer as elective indication for temporary loop stoma construction confirms the high complications rate and mortality rate associated with stoma closure. Intraperitoneal drains should be omitted after loop stoma closure.