Patients with rectal cancer having neoadjuvant chemoradiation do not have increased complications of ileostomy closure

Abstract

OBJECTIVES: It is conceivable that reversal of an ileostomy after low anterior resection following neoadjuvant therapy (NAT) may involve anastomosis of small bowel exposed to irradiation. The aim was to evaluate peri-operative complications of ileostomy closure and to compare the histology of ileal mucosa in excised stomas in patients who received NAT with those without NAT. METHODS: Twenty patients who underwent rectal excision following NAT for cancer, were compared with 20 control patients who underwent rectal excision without NAT. All patients received a diverting loop ileostomy which was subsequently reversed with excision of the ileostomy. The clinical outcome and histopathological features after reversal were evaluated. RESULTS: There was no significant difference with regard to peri-operative complications such as post-operative deaths related to ileostomy closure, anastomotic leakage, retraction of stoma or small bowel fistulae. Resection margins revealed no significant difference in crypt distortion, depletion of mucin, acute inflammation, chronic inflammation and infiltration of eosinophils following NAT compared with Controls. CONCLUSIONS: Neoadjuvant therapy for rectal cancer does not result in higher morbidity following closure of diverting loop ileostomy or result in significant inflammatory changes in the ileum. Therefore ileostomy closure is as safe in those with preoperative radiotherapy as in those without neoadjuvant therapy.