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Session:: ePosters-Mon800-M8: Benign Abdominal

EP783 - Impact of Diverting Loop Ileostomy and Reversal Timing on Long-Term Renal Outcomes in Rectal Cancer Patients

Monday, May 11, 2026
8:21 AM - 8:26 AM ET

    ePoster Presenter(s)

  • Megan Boyer, MD (she/her/hers)

    General Surgery Resident
    University of Rochester
    University of Rochester
    Rochester, NY, United States

    Disclosure information not submitted.

    View ePoster

    • Author(s)

  • Bailey Hilty Chu, MD (she/her/hers)

    General Surgery Resident
    University of Rochester Medical Center
    University of Rochester Medical Center
    Rochester, NY, United States

    Disclosure information not submitted.

  • TD

    Totadri Dhimal, MD

    Surgery Resident
    University of Rochester
    Rochester, New York, United States

    Disclosure information not submitted.

  • Anthony Loria, MD

    Resident
    University of Rochester Medical Center
    University of Rochester Medical Center
    Rochester, NY, United States

    Disclosure information not submitted.

  • PC

    Paula Cupertino, n/a

    Professor Vice-Chair Community Engagement IN surgery
    University of rochester medical center
    rochester, New York, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • FF

    Fergal Fleming, MD MPH FRCSI FACS

    Associate Professor of Surgery and Oncology
    University of Rochester Medical Center
    University of Rochester Medical Center
    Rochester, NY, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Purpose/Background: Rectal cancer patients undergoing surgical resection with a diverting loop ileostomy (DLI) are at a higher risk of acute renal insults, including acute kidney injury or readmission for electrolyte disturbances. These short-term complications are often attributed to challenges with stoma output, dehydration, and underlying comorbidities that predispose patients to renal injury. However, long-term renal outcomes in this population, including the risk of developing end-stage renal disease (ESRD), are less well characterized. In particular, the effect of temporary DLI and the timing of reversal on long-term renal function remains unclear. This study aims to evaluate the incidence of ESRD among this population and to examine how stoma reversal timing impacts ESRD risk.

Methods/Interventions: This is a population-based, retrospective cohort study utilizing data from the Statewide Planning and Research Cooperative System paired with New York State Cancer Registry. Adults diagnosed with locoregional rectal cancer between 2009 and 2019 who underwent low anterior resection (LAR) with DLI were included. Patients with a diagnosis of ESRD preceding their index resection were excluded. Stoma reversal was defined as occurring within two years of the index surgery. Claims were followed through 2024 to capture new cases of ESRD. The primary outcome was the development of ESRD after surgery, and the secondary outcome was the effect of ostomy reversal timing on ESRD.

Results/Outcomes: Among 3,006 patients who underwent LAR with DLI, 71.9% (n=2,161) underwent stoma reversal. Overall, 6% of the cohort developed ESRD within the study period, with a significantly higher incidence among patients who were not reversed compared with those who were reversed (9.0% vs. 4.9%, p< 0.0001). In an adjusted Cox proportional hazards model accounting for age, race, and comorbidities, patients who were not reversed had a 73% higher hazard of ESRD compared with those who were reversed (HR 1.73, 95% CI 1.28-2.34). Patients reversed between one and two years after their index surgery had a 2.5-fold higher hazard of ESRD compared with those reversed within one year (HR 2.50, 95% CI 1.64-3.81).

Conclusion/Discussion: Rectal cancer patients with a DLI experienced a notable risk of ESRD during long-term follow-up. Stoma reversal within the first year after resection and diversion was associated with a substantially reduced risk of ESRD compared with reversal after one year. These findings underscore the importance of timely ileostomy reversal to reduce long-term renal complications within this population.

Cohort characteristics