Multi-institutional assessment of sphincter preservation for rectal cancer.

Abdelsattar, Zaid M.; Wong, Sandra L.; Birkmeyer, Nancy J. O.; Cleary, Robert K.; Times, Melissa; Figg, Ryan; Peters, Nanette; Krell, Robert W.; Campbell, Darrell A.; Hendren, Samantha

doi:10.1200/jco.2014.32.3_suppl.566

Cited by 1 publication

(4 citation statements)

References 12 publications

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“…In our study, a permanent stoma was created in about one‐quarter of patients with mid or low rectal cancer, which included patients who underwent APR as initial surgery (15.4%) and patients in whom a permanent stoma was created after SPS (11.3%). The APR rate was lower than that of previous studies, where it ranged from 23.4% to 41% .…”

Section: Discussioncontrasting

confidence: 82%

“…Our subgroup analyses showed that tumour distance from the anal verge was the only predictor of permanent stoma creation not only in APR as initial surgery but also after SPS as initial surgery. Postoperative factors, such as surgical complications and recurrence, were significant factors in prior studies evaluating permanent stoma after SPS , and tumour distance from the anal verge was a significant predictor of APR as initial surgery . The fact that tumour distance is a predictor of permanent stoma after SPS in our study may be explained by prior findings that lower tumour height is associated with local recurrence and surgical complications .…”

Section: Discussionsupporting

confidence: 58%

“…Based on an analysis of risk factors for APR as initial surgery in a previous study, the decision to perform APR or SPS might represent the surgeon’s preference, the quality of the hospital or surgical difficulty . It is possible that patients were overlooked if a permanent stoma was created after unnecessary SPS.…”

Section: Discussionmentioning

confidence: 99%

“…The National Comprehensive Cancer Network guidelines for rectal cancer recommend performing APR if the tumour directly involves the anal sphincter or the levator muscles, or if margin‐negative resection of the tumour would result in loss of anal sphincter function and incontinence . However, neoadjuvant radiotherapy, age, tumour size and tumour distance from the anal verge have also been reported as predictors of APR . In addition, comorbidities, surgical complications, anastomotic leakage and local recurrence are associated with the creation of a permanent stoma after SPS .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 82%