Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas

Lee, Chul Min; Huh, Jung Wook; Park, Yoon Ah; Cho, Yong Beom; Kim, Hee Cheol; Yun, Seong Hyeon; Lee, Woo Yong; Chun, Ho-Kyung

doi:10.3349/ymj.2015.56.2.447

Cited by 32 publications

(32 citation statements)

References 19 publications

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“…The present study is in line with a few published studies, reporting that permanent stoma is associated with older patients (age<65) [22] and higher incidence of postoperative complications, including anastomotic leakage [22][23][24][25][26]. The present study also reports that permanent stoma is associated with higher CRP on postoperative days 3 and 4, and a higher proportion of patients who breached the CRP threshold on postoperative days 4.…”

Section: Discussionsupporting

confidence: 92%

The relationship between systemic inflammation and stoma formation following anterior resection for rectal cancer: A cross-sectional study

Khor

McSorley

Horgan

et al. 2017

International Journal of Surgery

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Tel: 0141 211 4000Running title: Inflammation and permanent stoma rate Disclosure: no conflicts of interest, no financial support/interests Keywords: colorectal cancer, stoma, stress response, morbidity 2 Abstract IntroductionThere is evidence that temporary defunctioning stoma formation in patients undergoing anterior resection reduces the risk of anastomotic leakage. The aim of the present study was to investigate the relationship between stoma formation, the postoperative systemic inflammatory response and complications following anterior resection for rectal cancer. ResultsOf the 167 patients, the majority were male (61%) and over 65 years old (56%) with node negative disease (60%). 36 patients (22%) underwent preoperative neoadjuvant treatment. 100 patients (60%) had a stoma formed at the time of surgery. Stoma formation was significantly associated with male sex (69% vs. 50%, p=0.017), neoadjuvant chemoradiotherapy (30% vs 9%, p=0.001) and open surgery (71% vs. 55%, p=0.040). Of those 100 patients who had a stoma formed, 80 had it reversed. Permanent stoma was significantly associated with increasing age (p=0.011), exceeding the established CRP threshold of 150mg/L on postoperative day 4 (67% vs 37%, p=0.039), higher incidence of 3 postoperative complications (76% vs 47%, p=0.035), anastomotic leakage (24% vs 2%, p=0.003) and higher Clavien Dindo score (p=0.036). ConclusionsThere was no significant association between stoma formation during anterior resection and the postoperative systemic inflammatory response. However, in these patients both the postoperative systemic inflammatory response and complications were associated with permanent stoma.  Both inflammatory response and complications were associated with permanent stoma.5

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Section: Discussionsupporting

confidence: 92%

The relationship between systemic inflammation and stoma formation following anterior resection for rectal cancer: A cross-sectional study

Khor

McSorley

Horgan

et al. 2017

International Journal of Surgery

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“…Up to a quarter of patients who undergo sphincter-saving surgery with a temporary stoma may consequently remain in the permanent stoma status, including nonreversal conditions or re-creation of another stoma after stoma-closure surgery [4567]. A review of the factors associated with a permanent stoma after a low anterior resection showed old age, anastomotic complications including leakage, radiation therapy, incurable local pelvic recurrence, systemic disease, and irreversible poor anal sphincter function after surgery to be significant [4567].…”

mentioning

confidence: 99%

“…A review of the factors associated with a permanent stoma after a low anterior resection showed old age, anastomotic complications including leakage, radiation therapy, incurable local pelvic recurrence, systemic disease, and irreversible poor anal sphincter function after surgery to be significant [4567]. …”

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confidence: 99%

Stoma Creation After Surgery for Rectal Cancer: Temporary or Permanent?

Huh

2015

Ann Coloproctol

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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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Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas

Cited by 32 publications

References 19 publications

The relationship between systemic inflammation and stoma formation following anterior resection for rectal cancer: A cross-sectional study

The relationship between systemic inflammation and stoma formation following anterior resection for rectal cancer: A cross-sectional study

Stoma Creation After Surgery for Rectal Cancer: Temporary or Permanent?

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

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