Effects of stage I opening and stage II opening of prophylactic ileostomy on postoperative recovery in low rectal cancer: a prospective study

Objective To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer. Methods The prospective study was conducted. The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected. According to random number table, patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage I opening were allocated into experimental group, and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group. Observation indicators: (1) comparison of postoperative clinical endpoints indices; (2) comparison of postoperative complications; (3) comparison of stress response indices. Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients. The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge. The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation. Patients returned to hospital if there was any discomfort after discharge, and were re-admitted if necessary. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Results Eighty-eight patients were screened for eligibility, including 61 males and 27 females, aged from 44 to 74 years, with an average age of 61 years. There were 45 patients in the experimental group and 40 in the control group, respectively. (1) Comparison of postoperative clinical endpoints indices: the operation time, time to first semiliquid diet, postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses were (122±9)minutes, (5.1±1.6)days, (54±8)hours, 18.6±1.5, (6.7±1.2)days, (53 269±2 888)yuan in the experimental group, and (128±10)minutes, (6.4±2.4)days, (65±7)hours, 17.1±1.3, (8.1±1.4)days, (59 419±1 921)yuan in the control group, respectively. There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716, 1.329, P>0.05). There were significant differences in the postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses between the two groups (t=8.688, 5.850, 3.897, 11.707, P 0.05). The incidence of system complications was 17.8%(8/45) in the experimental group, including 2 case of acute urinary retention, 2 of incisional infection, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities; the incidence of system complications was 20.9%(9/43) in the control group, including 1 case of acute urinary retention, 1 of incisional infection, 1 of intestinal obstruction, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities, 1 of anastomotic fistula; there was no significant difference in the incidence of system complications between the two groups (χ2=0.140, P>0.05). There was no death in the two groups. Patients with postoperative anastomotic leakage in the experimental group were recovered and discharged after re-surgical exploration and continuous abdominal irrigation, and the remaining patients were discharged after active conservative treatment. (3) Comparison of stress response indices: from preoperation to postoperative 5 days, the C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) were changed from (2.2±0.7)ng/L to (43.9±12.0)ng/L, from (12.2±1.9)fmmol/L to (11.3±1.4)fmmol/L, from (95±17)ng/L to (107±14)ng/L in the experimental group, and from (2.2±0.8)ng/L to (58.8±10.7)ng/L, from (11.6±1.6)fmmol/L to (12.7±1.3)fmmol/L, from (94±16)ng/L to (117±13)ng/L in the control group, respectively, showing significant differences in the changing trends of CRP, TNF-α, IL-6 between the two groups (F=260.042, 55.428, 120.337, P 0.05). Conclusion Compared with stage Ⅱ opening, stage Ⅰ opening of prophylactic ileostomy in laparoscopic rectal resection for low rectal cancer is safe and effective, which can reduce postoperative stress response and promote patients′ rehabilitation. Key words: Rectal neoplasms; Rectal cancer; Infection; Ileostomy; Stoma opening; Stress response; Postoperative recovery