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.

Authors

Masaaki Miyo, Mamoru Uemura, Yuki Ozato, Yoshinori Kagawa, Yozo Suzuki, Masaru Sasaki, Yusuke Matsuura, Taishi Hata, Kiminori Yanagisawa, Mitsuyoshi Tei, Yusuke Takahashi, Hideki Osawa, Genta Sawada, Takayuki Ogino, Norikatsu Miyoshi, Hirofumi Yamamoto, Kohei Murata, Yuichiro Doki, Hidetoshi Eguchi, Clinical Study Group of The University of Osaka, Colorectal Group (CSGO-CG)

Published in

Journal of gastroenterology. Oct 20, 2026. Epub Oct 20, 2026.

Abstract

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.
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.
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.
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.
UMIN000038150.

PMID:
42900361
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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