Determinants of stoma reversal in rectal cancer patients who had an anterior resection between 2009 and 2012 in the English National Health Service

Kuryba, Angela; Scott, Nigel; Hill, James E.; Meulen, Jan van der; Walker, Kate

doi:10.1111/codi.13339

Cited by 47 publications

(50 citation statements)

References 18 publications

(33 reference statements)

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“…Although defunctioning stomas are intended to be temporary at the time of surgery, up to 25% will become permanent (Kuryba et al ., ; Sier et al ., ). The ACPGBI National Bowel Cancer Audit of 4879 patients who had an ileostomy during anterior resection between 2009 and 2012 reported a reversal rate of 72.5% within 18 months (Kuryba et al ., ).…”

Section: Surgical Managementmentioning

confidence: 99%

“…Even though anterior resection may be feasible, other factors such as body habitus, pre-existing incontinence, need for preoperative therapy or co-morbidities may mean that a permanent stoma is a better option for some patients (How et al, 2012). Although defunctioning stomas are intended to be temporary at the time of surgery, up to 25% will become permanent (Kuryba et al, 2016;Sier et al, 2015). The ACPGBI National Bowel Cancer Audit of 4879 patients who had an ileostomy during anterior resection between 2009 and 2012 reported a reversal rate of 72.5% within 18 months (Kuryba et al, 2016).…”

Section: Rates Of Permanent Stoma Formationmentioning

confidence: 99%

“…Although defunctioning stomas are intended to be temporary at the time of surgery, up to 25% will become permanent (Kuryba et al, 2016;Sier et al, 2015). The ACPGBI National Bowel Cancer Audit of 4879 patients who had an ileostomy during anterior resection between 2009 and 2012 reported a reversal rate of 72.5% within 18 months (Kuryba et al, 2016). Although most surgeons aim to reverse a stoma within 2-4 months of initial surgery, the median time to closure was 10 months, possibly due to postoperative complications, adjuvant chemotherapy or reversal having a lower organizational priority.…”

Section: Rates Of Permanent Stoma Formationmentioning

confidence: 99%

See 2 more Smart Citations

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Surgical Management

et al. 2017

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Section: Surgical Managementmentioning

confidence: 99%

Section: Rates Of Permanent Stoma Formationmentioning

confidence: 99%

Section: Rates Of Permanent Stoma Formationmentioning

confidence: 99%

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Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Surgical Management

et al. 2017

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“…However, neoadjuvant radiotherapy, age, tumour size and tumour distance from the anal verge have also been reported as predictors of APR [3][4][5][6][7][8]. In addition, comorbidities, surgical complications, anastomotic leakage and local recurrence are associated with the creation of a permanent stoma after SPS [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function

Kim

et al. 2019

Colorectal Disease

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Aim Preoperative factors predictive of permanent stoma creation were investigated in a long‐term follow‐up of patients with mid or low rectal cancer. Method We included patients who underwent radical resection for mid or low rectal cancer with available data for preoperative anal function measured by manometry and Faecal Incontinence Severity Index questionnaire between January 2005 and December 2015 in three tertiary referral hospitals. A permanent stoma was defined as a stoma present until the patient’s last follow‐up visit or death. Preoperative factors that predicted permanent stoma creation were analysed. Results Over a median follow‐up of 57.4 months (range 12–143 months), a permanent stoma was created in 144/577 (25.0%) patients, including 89 (15.4%) who underwent abdominoperineal resection, one (0.2%) who underwent Hartmann’s operation without reversal, 15 (2.6%) with a diverting ileostomy at the time of initial sphincter‐preserving surgery without undergoing stoma reversal, and 39 (6.8%) who underwent permanent ileostomy formation after sphincter‐preserving surgery. Patients with permanent stoma creation had a shorter tumour distance from the anal verge (P < 0.001), larger tumour size (P = 0.020) and higher preoperative Faecal Incontinence Severity Index score (P = 0.020). On multivariable analysis, tumour distance from the anal verge predicted permanent stoma formation (relative risk 0.53 per centimetre increase; 95% confidence interval 0.46–0.60; P < 0.001) but preoperative anal function did not. Conclusion Tumour distance from the anal verge was the only preoperative determinant of permanent stoma creation in rectal cancer patients. These data may help mid and low rectal cancer patients understand the need for permanent stoma.

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“…Anastomotic leakage is the best studied risk factor for non-reversal, but high age and advanced tumor stage is also described [6][7][8][9]. Studies from countries with a social structure similar to Sweden have indicated that socioeconomic factors may also affect stoma reversal rates [9][10][11]. Road distance between home and hospital has not been studied as a risk factor for non-reversal.…”

Section: Introductionmentioning

confidence: 99%

Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

Näverlo

Strigård

Gunnarsson

2019

Int J Colorectal Dis

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Purpose To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma. Methods Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden. Results In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of nonreversal than those living farther away (OR 0.3; 95% CI 0.12-0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82-1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery. Conclusions Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.

show abstract

Determinants of stoma reversal in rectal cancer patients who had an anterior resection between 2009 and 2012 in the English National Health Service

Cited by 47 publications

References 18 publications

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Surgical Management

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Surgical Management

Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function

Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

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