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

Abstract

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.

Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables

“…It is important to note, however, that the confidence intervals are still quite wide in most instances, reflecting the inherent difficulty in predicting a permanent stoma outcome from registry-based data alone. Clinicians and patients should interpret the results cautiously, keeping in mind in particular that some predictors, unmeasured in this study, might increase the stoma risk even further, such as alcohol and smoking abuse 25 , low socioeconomic status 26 , and an inflammatory state 23,24 . Further predictive research should include other factors of potential importance that are known before operation.…”

Ostomy Does Not Lead to Worse Outcomes After Bowel Resection With Ovarian Cancer: A Systematic Review

“…Moreover, studies of colorectal cancer might suggest some factors that could affect decision-making when ovarian cancer is involved. For example, the distance from the tumor to the anal verge was associated with the AL rate and survival outcomes of colon cancer; this has been proven but is not usually considered an indication by physicians treating ovarian cancer ( 23 , 37 ).…”

A nomogram to predict the incidence of permanent stoma in elderly patients with rectal cancer

“…In our study, PS developed in 58/278 (20.86%) patients with rectal cancer, which included 54 patients in whom stoma was created during initial surgery and four patients who underwent re-stoma after stoma reversal. Postoperative AL was a common and severe complication in patients with rectal cancer, especially low and ultra-low rectal cancer, causing poor postoperative recovery, longer hospital stays, anorectal dysfunction, and even death (17). It has been reported that tumor recurrence and AL were common independent risk factors for PS (12).…”

“…The continued existence of stoma may alter bowel habits, and could ultimately led to stoma-related complications including stoma hernia, stoma bleeding, stoma prolapse, dehydration, and electrolyte disorders (14,15). Numerous studies (4,8,(16)(17)(18) investigating the risk factors for PS have found that comorbidities, surgical complications, and tumor recurrence were commonly associated with PS (17).…”

“…Accordingly, a nomogram would help clinicians to predict the possibility of permanent diverting stoma for rectal cancer patients. Furthermore, prior studies only focused on predictors of PS after temporary stoma (TS) for patients of all ages (4,6,(8)(9)(10)17). In our study, we assessed the incidence of PS, identified independent risk factors, and constructed a predictive nomogram for elderly rectal cancer patients.…”