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Revised risk factors and patient characteristics for failure to close a defunctioning ileostomy following low anterior resection for locally advanced rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Our clinical experience led us to raise questions about the validity of the reported risk factors and patient characteristics associated with permanent stomas after sphincter-preserving resection for rectal cancer.

Objective

The present retrospective study aimed to identify and compare our center’s incidence and risk factors for a permanent ostomy after low anterior resection (LAR) with a diverting stoma for locally advanced mid and low rectal cancer with those in published reports.

Patients

A total of 239 patients underwent a sphincter-preserving procedure (LAR) for rectal cancer between 2000 and 2018, and 236 of them (age range 33–83 years, 100 males (42%)) were included in the analysis. The study cohort was divided into 2 groups comprised of patients with and without permanent stomas after rectal cancer surgery.

Results

Only 25 of the 236 operated patients (10.6%) remained with permanent stomas after rectal cancer surgery. Factors associated with stoma non-closure in the multivariate analysis were pathological stage 3 (13 (52%) vs 51 (24.2%) for patients with closed stomas, p = 0.032), disease recurrence (14 (56%) vs 40 (18.9%), respectively, p = 0.048), length of stay > 10 days, p = 0.032), and anastomotic leaks with a Clavien–Dindo score > 2 or reoperations (6 (24%) vs 13 (6.1%), p = 0.019).

Conclusions

Sphincter-preserving surgery for rectal cancer was associated with a lower incidence of stoma non-closure than published values. The major risk factors for non-closure were aggressive disease and severe complications of surgery.

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Authors and Affiliations

  1. Colorectal Unit, Division of Surgery, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Alex Barenboim, Ravit Geva & Hagit Tulchinsky

  2. GIT malignancies Center, Division of Oncology, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Alex Barenboim, Ravit Geva & Hagit Tulchinsky

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  1. Alex Barenboim
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  2. Ravit Geva
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Correspondence to Hagit Tulchinsky.

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This paper was presented as a poster at the Annual meeting of the American Society of Colon and Rectal Surgeons in Nashville, TN, May 19-23, 2018. E-poster Number: P435.

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Barenboim, A., Geva, R. & Tulchinsky, H. Revised risk factors and patient characteristics for failure to close a defunctioning ileostomy following low anterior resection for locally advanced rectal cancer. Int J Colorectal Dis 37, 1611–1619 (2022). https://doi.org/10.1007/s00384-022-04188-6

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