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Characteristics and Risk Factors Associated with Permanent Stomas After Sphincter-Saving Resection for Rectal Cancer

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Abstract

Background

The aim of the present study was to identify the risk factors and patient characteristics associated with permanent stomas after sphincter-saving resection for rectal cancer.

Method

Between 2000 and 2007, 2,362 patients underwent sphincter-saving surgery [low anterior resection or ultra-low anterior resection (uLAR)] for rectal cancer. These patients were divided into two groups: 71 patients with permanent stomas and 2,291 patients without permanent stomas after rectal cancer surgery.

Results

Of the 71 permanent stomas (3 % of the patients), 34 (48 %) were ileostomies, 11 (15 %) were loop colostomies, 10 (14 %) were treated by Hartmann’s operation, and 16 (23 %) were treated by abdominoperineal resection. Diverting stomas were created in 364 patients; 3 % (n = 11) of them could not be reversed due to anastomosis-related complications. Permanent stomas were constructed at a median of 20 months after sphincter-saving surgery for rectal cancer. The main causes of permanent stomas were local recurrence (n = 27), anastomotic leakage (n = 12), fistula (n = 9), and anastomosis site stricture (n = 7). The main causes of early permanent stomas (<1 year) were anastomosis-related complications, whereas for late permanent stomas (≥1 year), the main cause was local cancer recurrence. The independent risk factors for permanent stomas were local recurrence, postoperative pelvic sepsis, male gender of the patient, the uLAR operation type, and perioperative radiation therapy.

Conclusions

In a high-volume surgical center, sphincter-saving surgery for rectal cancer is associated with a low incidence of permanent stoma.

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References

  1. Griffen FD, Knight CD Sr, Whitaker JM (1990) The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 211:745–751 (discussion 751–742)

    Article  PubMed  CAS  Google Scholar 

  2. Heald R, Chir M, Leicester R (1981) The low stapled anastomosis. Dis Colon Rectum 24:437–444

    Article  PubMed  CAS  Google Scholar 

  3. Knight C, Griffen F (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710

    PubMed  CAS  Google Scholar 

  4. den Dulk M, Smit M, Peeters KCMJ et al (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8:297–303

    Article  Google Scholar 

  5. Junginger T, Gonner U, Trinh TT et al (2010) Permanent stoma after low anterior resection for rectal cancer. Dis Colon Rectum 53:1632–1639

    Article  PubMed  Google Scholar 

  6. Mealy K, O’Broin E, Donohue J et al (1996) Reversible colostomy—what is the outcome? Dis Colon Rectum 39:1227–1231

    Article  PubMed  CAS  Google Scholar 

  7. Kairaluoma M, Rissanen H, Kultti V et al (2002) Outcome of temporary stomas. A prospective study of temporary intestinal stomas constructed between 1989 and 1996. Dig Surg 19:45–51

    Article  PubMed  CAS  Google Scholar 

  8. Pokorny H, Herkner H, Jakesz R (2005) Mortality and complications after stoma closure. Arch Surg 140:956–960 (discussion 960)

    Article  PubMed  Google Scholar 

  9. Bailey CM, Wheeler JM, Birks M et al (2003) The incidence and causes of permanent stoma after anterior resection. Colorectal Dis 5:331–334

    Article  PubMed  CAS  Google Scholar 

  10. David GG, Slavin JP, Willmott S et al (2010) Loop ileostomy following anterior resection: is it really temporary? Colorectal Dis 12:428–432

    Article  PubMed  CAS  Google Scholar 

  11. Maggiori L, Bretagnol F, Lefèvre J et al (2011) Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13:632–637

    Article  PubMed  CAS  Google Scholar 

  12. Lindgren R, Hallböök O, Rutegård J et al (2011) What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54:41

    Article  PubMed  Google Scholar 

  13. Tsikitis VL, Larson DW, Poola VP et al (2009) Postoperative morbidity with diversion after low anterior resection in the era of neoadjuvant therapy: a single institution experience. J Am Coll Surg 209:114–118

    Article  PubMed  Google Scholar 

  14. Williams N, Durdey P, Johnston D (1985) The outcome following sphincter-saving resection and abdomino-perineal resection for low rectal cancer. Br J Surg 72:595–598

    Article  PubMed  CAS  Google Scholar 

  15. Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    Article  PubMed  CAS  Google Scholar 

  16. Di Betta E, D’Hoore A, Filez L et al (2003) Sphincter saving rectum resection is the standard procedure for low rectal cancer. Int J Colorectal Dis 18:463–469

    Article  PubMed  Google Scholar 

  17. Matthiessen P, Hallbook O, Rutegard J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed  Google Scholar 

  18. Gastinger I, Marusch F, Steinert R et al (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142

    Article  PubMed  CAS  Google Scholar 

  19. Nelson RS, Boland E, Ewing BM et al (2009) Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer. Am J Surg 198:765–770

    Article  PubMed  Google Scholar 

  20. Peeters KC, Tollenaar RA, Marijnen CA et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216

    Article  PubMed  CAS  Google Scholar 

  21. Lipska MA, Bissett IP, Parry BR et al (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76:579–585

    Article  PubMed  Google Scholar 

  22. Law WI, Chu KW, Ho JW et al (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96

    Article  PubMed  CAS  Google Scholar 

  23. Peeters KC, van de Velde CJ, Leer JW et al (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch Colorectal Cancer Group study. J Clin Oncol 23:6199–6206

    Article  PubMed  CAS  Google Scholar 

  24. Pakkastie TE, Ovaska JT, Pekkala ES et al (1997) A randomised study of colostomies in low colorectal anastomoses. Eur J Surg 163:929–933

    PubMed  CAS  Google Scholar 

  25. Nesbakken A, Nygaard K, Lunde OC (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404

    Article  PubMed  CAS  Google Scholar 

  26. Cavaliere F, Pemberton JH, Cosimelli M et al (1995) Coloanal anastomosis for rectal cancer. Long-term results at the Mayo and Cleveland clinics. Dis Colon Rectum 38:807–812

    Article  PubMed  CAS  Google Scholar 

  27. Machado M, Hallbook O, Goldman S et al (2002) Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: a comparison between two hospitals with a different policy. Dis Colon Rectum 45:940–945

    Article  PubMed  Google Scholar 

  28. Kim KH, Yu CS, Yoon YS et al (2011) Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery. Dis Colon Rectum 54:1107–1113

    Article  PubMed  Google Scholar 

  29. Norton C, Kamm MA (1999) Outcome of biofeedback for faecal incontinence. Br J Surg 86:1159–1163

    Article  PubMed  CAS  Google Scholar 

  30. Heymen S, Jones KR, Ringel Y et al (2001) Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 44:728–736

    Article  PubMed  CAS  Google Scholar 

  31. Byrne CM, Solomon MJ, Young JM et al (2007) Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 50:417–427

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnab-2-Dong Songpa-Ku, Seoul, 138-736, South Korea

    Seok In Seo, Chang Sik Yu, Gwon Sik Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim & Jin Cheon Kim

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  1. Seok In Seo
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  2. Chang Sik Yu
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  3. Gwon Sik Kim
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Correspondence to Chang Sik Yu.

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Seo, S.I., Yu, C.S., Kim, G.S. et al. Characteristics and Risk Factors Associated with Permanent Stomas After Sphincter-Saving Resection for Rectal Cancer. World J Surg 37, 2490–2496 (2013). https://doi.org/10.1007/s00268-013-2145-z

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  • DOI: https://doi.org/10.1007/s00268-013-2145-z

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