Assessing the pathway and timing for ileostomy reversal in rectal cancer: A retrospective cohort study

Surgery for locally advanced rectal cancer often requires temporary fecal diversion, which significantly impacts quality of life and can lead to unintended morbidity. Patients typically are counseled that reversal is planned for 3 months postoperatively, but the actual time to reversal and factors that may delay closure are poorly understood. We aimed to evaluate time from diversion to ostomy reversal, with secondary outcomes including patient- and systems-level factors influencing this timeline.

This retrospective cohort study included patients with stage I-III rectal cancer who underwent low anterior resection with diverting loop ileostomy between 2011 and 2022 at a tertiary center. Median time to reversal and intervals to prereversal events were determined. A stepwise Cox proportional hazards model was used to identify factors associated with prolonged time to reversal, whereas Kaplan-Meier methods were applied to estimate median time to reversal for subgroups.

Among 133 patients, 79.0% (n = 105) had their stomas reversed after a median of 5.5 months. Delays were observed in time to follow-up appointments, endoscopic evaluations, and gastrografin enemas. Prolonged time to closure was associated with receipt of adjuvant therapy (hazard ratio, 0.50; 95% confidence interval, 0.29-0.85), ASA status ≥3 (hazard ratio, 0.59; 95% confidence interval, 0.39-0.90), Clavien-Dindo complications ≥3 (hazard ratio, 0.32; 95% confidence interval, 0.11-0.91), persistent anastomotic disruption (hazard ratio, 0.36; 95% confidence interval, 0.15-0.85), and more follow-up appointment cancellations (hazard ratio, 0.35; 95% confidence interval, 0.18-0.68).

Stoma reversal often exceeds the anticipated 3-month timeline as the result of patient risk factors and anastomotic evaluation protocols. Identifying these barriers is essential to develop standardized, timely, and patient-centered reversal metrics.