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Most temporary stomas made to protect a join in the bowel are reversed, and a meaningful minority are not. In a series of 639 patients having sphincter-sparing surgery, 11.9 per cent still had a stoma two years later; the main reasons were the cancer progressing (52.4 per cent) and the patient deciding against it (19.0 per cent).
A defunctioning ileostomy diverts the stream away from a new join in the rectum, so that if the join leaks it does so without faeces passing through. It is described to the patient as temporary. That description is right most of the time and it is worth knowing the proportion.
How many are reversed. The figure depends on the series and on how long it is measured over. A Spanish multicentre retrospective cohort of 639 consecutive patients having sphincter-sparing anterior resection between 2016 and 2020 looked at stoma-free status at two years: 11.9 per cent had a permanent stoma. Anastomotic leak made reversal much less likely (86.3 per cent closed without a leak against 69.4 per cent with one). The reasons for not reversing a primary stoma were disease progression in 52.4 per cent and the patient's own decision in 19.0 per cent. A single-centre series of 348 patients with a median follow-up of 50.4 months reported 93.1 per cent reversed and 6.9 per cent permanent, with the same risk factors. A review article in the same journal gives the commonly quoted figure that "approximately 20% of diverting stomas become permanent or are converted to end colostomies". The honest statement to a reader is that roughly one in ten to one in five is not reversed, that the risk is higher after a leak, after radiotherapy and with recurrence, and that no single national figure exists.
When it should happen. A multicentre cohort of 905 patients who had anterior resection with a defunctioning stoma between 2014 and 2018 found at least one complication within 90 days of reversal in 116 (18 per cent). The elapsed time to reversal was associated with complications (odds ratio 1.02 per unit), and reversal more than six months after the original operation carried an odds ratio of 1.73 (1.04 to 2.86). Anastomotic leak and nodal disease were themselves associated with delay, so part of this is confounding by indication, and the authors' recommendation is still to close early, preferably within six months.
The risk of the reversal operation. Leak after reversal is not rare. In 361 patients having ileostomy reversal after curative rectal resection, 52 (14.4 per cent) leaked, at a median of 5.7 months; an anastomosis less than 7 cm from the anal verge, a side-to-end configuration, an involved circumferential resection margin and adjuvant radiotherapy all predicted it, and five-year overall survival was 63.4 per cent with a post-reversal leak against 90.3 per cent without. That survival difference is an association in a retrospective series and should be read as a marker of who leaks rather than proof that the leak caused the deaths.
What the bowel is like afterwards. Reversal is not the end of the story: low anterior resection syndrome, the urgency, clustering and frequency that follow a low join, is covered elsewhere in the corpus and is the reason some people who could have a reversal choose not to.
What comes back, and when: the stoma goes and continence does not immediately follow it. Bowel function after reversal improves over the first one to two years and often does not return to what it was. Pelvic floor rehabilitation is the treatment with the most evidence behind it and has its own record here.
A diverting stoma converts a potentially fatal anastomotic leak into a managed one. The cost of that insurance is a second operation, a second anastomosis with its own leak rate, and the chance that the second operation never happens because the cancer returns or the person declines it. Every figure above is a measurement of that trade.
Query for this technology: (TITLE:"Stoma reversal after rectal cancer surgery: who gets the bowel joined up again" OR ABSTRACT:"Stoma reversal after rectal cancer surgery: who gets the bowel joined up again") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Stoma reversal after rectal cancer surgery: who gets the bowel joined up again, not a curated reading list.
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Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Colorectal cancer and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Colorectal cancer and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship, rehabilitation.