Gastrointest Cancer. 2024 Sep;55(3):1266-1273.doi: 10.1007/s12029-024-01062-2. Epub 2024 Jun 26.

V M Meyer ^1 2 3, N Bosch ⁴, J A G van der Heijden ⁴, A J Kalkdijk-Dijkstra ⁴, J P E N Pierie ^5 6, G L Beets ^7 8, P M A Broens ⁹, B R Klarenbeek ⁴, H L van Westreenen ¹⁰

Author information

¹Dept of Surgery, Isala Hospitals, Dokter Van Heesweg 2, 8025 AB, Zwolle, The Netherlands. meyervi@isala.nl.

²Dept of Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. meyervi@isala.nl.

³GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. meyervi@isala.nl.

⁴Dept of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands.

⁵Post Graduate School of Medicine (PGSOM), University Medical Center Groningen and University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.

⁶Dept of Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.

⁷Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.

⁸GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.

⁹Dept of Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.

¹⁰Dept of Surgery, Isala Hospitals, Dokter Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.

Abstract

Purpose: The aim of this study was to assess the effect of early stoma closure on bowel function after low anterior resection (LAR) for rectal cancer.

Methods: Patients participating in the FORCE trial who underwent LAR with protective stoma were included in this study. Patients were subdivided into an early closure group (< 3 months) and late closure group (> 3 months). Endpoints of this study were the Wexner Incontinence, low anterior resection syndrome (LARS), EORTC QLQ-CR29, and fecal incontinence quality of life (FIQL) scores at 1 year.

Results: Between 2017 and 2020, 38 patients had received a diverting stoma after LAR for rectal cancer and could be included. There was no significant difference in LARS (31 vs. 30, p = 0.63) and Wexner score (6.2 vs. 5.8, p = 0.77) between the early and late closure groups. Time to stoma closure in days was not a predictor for LARS (R² = 0.001, F (1,36) = 0.049, p = 0.83) or Wexner score (R² = 0.008, F (1,36) = 0.287, p = 0.60) after restored continuity. There was no significant difference between any of the FIQL domains of lifestyle, coping, depression, and embarrassment. In the EORTC QLQ-29, body image scored higher in the late closure group (21.3 vs. 1.6, p = 0.004).

Conclusion: Timing of stoma closure does not appear to affect long-term bowel function and quality of life, except for body image. To improve functional outcome, attention should be focused on other contributing factors.