Abstract
Purpose
This study evaluated the risk factors influencing permanent stoma after curative resection of rectal cancer and compared the long-term survival of patients according to the stoma state.
Methods
From January 2004 to December 2010, 895 consecutive rectal cancer patients with histological-confirmed adenocarcinoma who received low anterior resection with curative intent at the Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, were evaluated retrospectively. Patient demographics, times of stoma reversal, and number/reason of permanent stoma were evaluated.
Results
Three hundred fifteen patients (35.2 %) had a diverting stoma of temporary intent among 895 rectal adenocarcinoma patients. Loop ileostomy was performed in 271 patients (86.0 %). A total of 256 (81.3 %) of 315 stoma patients received stoma closure. The mean period between primary surgery and stoma closure was 5.6 months (range, 1–44 months). Seventy-three patients (23.2 %) were confirmed with permanent stoma. Multivariate analysis showed stage IV (hazard ratio (HR), 3.380; 95 % confidence interval (CI), 1.192–18.023; p = 0.027), anastomosis-related complication (HR, 3.299; 95 % CI, 1.397–7.787; p = 0.006), colostomy type (HR, 7.276, 95 % CI, 2.454–21.574; p = 0.000), systemic metastasis (HR, 2.698; 95 % CI, 1.1.288–5.653; p = 0.009), and local recurrence (HR, 4.231; 95 % CI, 1.724–10.383; p = 0.002) were independent risk factors for permanent stoma.
Conclusions
On postoperative follow-up, in patients with anastomotic complication, tumor progression with local recurrences and systemic metastasis may cause permanent stoma.
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References
Shiomi A, Ito M, Saito N, Hirai T, Ohue M, Kubo Y et al (2011) The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers. Colorectal Dis 13:1384–1389
Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (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
Shin US, Kim CW, Yu CS, Kim JC (2010) Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer. Int J Colorectal Dis 25:843–849
Bloemen JG, Visschers RG, Truin W, Beets GL, Konsten JL (2009) Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma. Dis Colon Rectum 52:1251–1258
Mala T, Nesbakken A (2008) Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 10:785–788
Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15:1099–1106
Yau T, Watkins D, Cunningham D, Barbachano Y, Chau I, Chong G (2009) Longitudinal assessment of quality of life in rectal cancer patients with or without stomas following primary resection. Dis Colon Rectum 52:669–677
Cakmak A, Aylaz G, Kuzu MA (2010) Permanent stoma not only affects patients’ quality of life but also that of their spouses. World J Surg 34:2872–2876
den Dulk M, Smit M, Peeters KC, Kranenbarg EM, Rutten HJ, Wiggers T 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
David GG, Slavin JP, Willmott S, Corless DJ, Khan AU, Selvasekar CR (2010) Loop ileostomy following anterior resection: is it really temporary? Colorectal Dis 12:428–432
Junginger T, Gonner U, Trinh TT, Lollert A, Oberholzer K, Berres M (2010) Permanent stoma after low anterior resection for rectal cancer. Dis Colon Rectum 53:1632–1639
Chun LJ, Haigh PI, Tam MS, Abbas MA (2012) Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum 55:167–174
Maggiori L, Bretagnol F, Lefevre JH, Ferron M, Vicaut E, Panis Y (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
Nelson RS, Boland E, Ewing BM, Blatchford GJ, Ternent C, Shashidharan M et al (2009) Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer. Am J Surg 198:765–770
Lindgren R, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P (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 54:41–47
Cooper R, Mason M, Finan P, Byrne P, Sebag-Montefiore D (2012) Defunctioning stomas prior to chemoradiation for anal cancer are usually permanent. Colorectal Dis 14:87–91
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
Acknowledgments
This study was supported by a grant (CRI11-063-1) of the Chonnam National University Hospital Research Institute of Clinical Medicine, and Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012010817).
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Lim, S.W., Kim, H.J., Kim, C.H. et al. Risk factors for permanent stoma after low anterior resection for rectal cancer. Langenbecks Arch Surg 398, 259–264 (2013). https://doi.org/10.1007/s00423-012-1038-1
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DOI: https://doi.org/10.1007/s00423-012-1038-1