TRYING TO OPTIMIZE THE TIMING OF RECONSTRUCTION OF GASTROINTESTINAL TRACT, ON THE EXAMPLE OF EARLY CLOSURE OF THE ILEOSTOMY IN PATIENTS WITH RECTAL CANCER. RANDOMIZED MULTICENTER STUDY

Aims: assessment of the safety of early closure of temporary ileostomy in patients with rectal cancer after the total end partial mesorectal excision.

Materials and methods: participants: patients of our clinical centers were examined with CT-proctography or rectoscopy to check whether bowel anastomoses were intact on 8-th day after the primary surgery. Patients with intact anastomoses who fulfilled the inclusion criteria were randomized to 2 groups: the first group, (n=37) with early closure of ileostomy (day 8-13 after stoma formation) and the second group (n=39) with deferred closure (after 12 weeks). It was expected that early closure would be a safe procedure.

Results: 76 participants were randomized; results of their treatment were analyzed. Time boards of reconstructive surgery do not result in terms of postoperative complications (8.1% in 1-st group versus 7.7% in control, p=0,08, not significant). However duration of reconstructive surgery in the group with the early closure of ileostomy was shorter (Tm in 1-st group = 51 min (28-127) versus 70 min (30-135) in second group, duration of surgery in intervention group was shorter in 1,37 times that one in control group (95% CI 1,28-1,46, p=0,02)).

Conclusion: early closure of ileostomy in patients after surgery for rectal cancer is feasible and doesn’t result in an increase the number of postoperative complications; it may be considered as an alternative to deferred closure. However, this problem should be studied in greater depth to evaluate both complications associated with ileostomy and the quality of the life.

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