Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study

Purpose: This study aimed to characterize bowel function, anorectal physiology, and health-related quality of life (HRQoL) in rectal cancer patients following low anterior resection (LAR), comparing three groups: a control group with late stoma closure (LSC) (>3 months), an early stoma closure group (ESC) (8-10 days), and an anastomotic leakage group (AL). Methods: This cross-sectional study evaluated anorectal function using anorectal manometry. Bowel function and HRQoL were assessed using the low anterior resection syndrome (LARS) score and the EORTC QLQ-CR29 questionnaires. Results: Of 124 eligible participants, 42 accepted participation. ESC and AL had significantly lower median (IQR) pressures in mmHg compared to LSC: rest: LSC: 54 (50-77), ESC: 35 (20-45), AL: 28 (22.5-33), p=0.001, p<0.001; squeeze: LSC: 140 (95-168), ESC: 70 (46-95), AL: 71 (45-81.5), p=0.010, p=0.004; squeeze pressure increments: LSC: 72 (60-89), ESC: 36 (30-48) and AL: 38 (25.5-54), p=0.003, p=0.004. ESC showed higher but non-significant median (IQR) volumes in ml: first sensation: LSC: 30 (20-40), ESC: 40 (30-50), p=0.153; urge: LSC: 55 (45-100), ESC: 90 (65-100) p=0.269; max: LSC: 110 (80-180), ESC: 142 (105-179), p=0.713. No differences in mean (95% CI) total LARS scores were observed: LSC: 26.5 (21.9-31.1), ESC: 29.5 (25.9-33.1), AL: 33.0 (28.0-38.0), p=0.320, p=0.051. Mean (95% CI) stool frequency was significantly higher in AL: 44.4 (32.1-56.8) compared to LSC: 29.4 (20.5-38.4), p=0.041. No differences in HRQoL were observed between the groups (p=0.681, p=0.129). Conclusion: No differences in anorectal function and HRQoL were observed between early and late reversal of diverting loop ileostomy.