Early Versus Late Stoma Closure in Patients With Rectal Cancer Who Undergo LAR: FORCE Trial Sub-Analysis

In patients with rectal cancer who undergo low anterior resection (LAR) surgery, closure of a temporary stoma takes place between 8 and 12 weeks following the initial operation.

While LAR offers benefits, including preservation of sphincter function and avoidance of a permanent stoma, many patients suffer from impaired bowel function after the procedure.

A new sub-analysis of the FORCE trial by V.M. Meyer, MD, and colleagues sought to determine the effect of early stoma closure on bowel function in patients who underwent LAR.

FORCE was a multicenter, randomized trial that investigated the effects of pelvic floor rehabilitation (PFR) after LAR compared with care without PFR. Patients who participated in the trial and underwent LAR with protective stoma were included in this sub-analysis.

Patients were divided into 2 groups, an early closure group (stoma closure took place within 3 months of LAR) and a late closure group (closure took place after 3 months). The study’s end points included Wexner Incontinence, low anterior resection syndrome (LARS), EORTC QLQ-CR29, and Fecal Incontinence Quality of Life (FIQL) scores at 1 year.

A total of 38 eligible patients who received a diverting stoma after LAR for rectal cancer were included in the study. No significant difference was found between the early and late closure groups in LARS (31 vs 30; P=.63) or Wexner Incontinence score (6.2 vs 5.8; P=.77).

Patients in the late closure group had significantly more anastomotic leaks (P<.001), admission days (P<.001), and a trend toward more postoperative complications at index surgery (P=.08).

Time to stoma closure in days was not a predictor for LARS (R²=0.001; F (1,36)=0.049; P=.83) or Wexner Incontinence score (R²=0.008; F (1,36)=0.287; P=.60) after restored continuity. No significant difference was noted between any FIQL domains of lifestyle, coping, depression, and embarrassment. In the EORTC QLQ-29 scores, body image scored higher in the late closure group (21.3 vs 1.6; P=.004).

The timing of stoma closure does not appear to affect long-term bowel function and quality of life (QOL), except for body image. Stoma closure within 3 months does not appear to improve long-term bowel function or health-related QOL. Improving functional outcomes of LAR should be based on other contributing factors.