The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer

Abstract

Aim The long-term risk of definitive stoma after sphincter-saving resection (SSR) for rectal cancer is underestimated and has never been reported for ultralow conservative surgery. We report the 10-year risk of definitive stoma after SSR for low rectal cancer.Method From 1994 to 2008, patients with low rectal cancer who were suitable for SSR were analysed retrospectively. Patients were divided into the following four groups: low colorectal anastomosis (LCRA); coloanal anastomosis (CAA); partial intersphincteric resection (pISR); and total intersphincteric resection (tISR). The end-point was the risk of a definitive stoma according to the type of anastomosis.Results During the study period, 297 patients had SSR for low rectal cancer. The incidence of definitive stoma increased from 11% at 1 year to 22% at 10 years. The reasons were no closure of the loop ileostomy (4.7%), anastomotic morbidity (6.5%), anal incontinence (8%) and local recurrence (5.2%). The risk of definitive stoma was not influenced by type of surgery: 26% vs 18% vs 18% vs 19% (P = 0.578) for LCRA, CAA, pISR and tISR, respectively. Independent risk factors for definitive stoma were age > 65 years and surgical morbidity. ConclusionThe risk of a definitive stoma after SSR increased two-fold between 1 and 10 years after surgery, from 11% to 22%. Ultralow conservative surgery (pISR and tISR) did not increase the risk of definitive stoma compared with conventional CAA or LCRA.

Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery

“…There have been rapid advances in laparoscopic procedures for low rectal cancer, and these have increased the probability of anal preservation in patients with very low rectal cancer and reduced use of abdominal perineal resection, which does not preserve anal function [1][2][3]. Accordingly, there has been increased use of temporary loop stoma creation to prevent severe complications caused by a lower anastomosis with a high risk of leakage, which has risk factors of preoperative chemoradiotherapy (CRT), male patients, and lower anastomotic level [4][5][6].…”

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

“…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].…”

Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery

“…There have been rapid advances in laparoscopic procedures for low rectal cancer, and these have increased the probability of anal preservation in patients with very low rectal cancer and reduced use of abdominal perineal resection, which does not preserve anal function [1][2][3]. Accordingly, there has been increased use of loop stoma creation to prevent severe complications caused by a lower anastomosis with a high risk of leakage, which has risk factors of preoperative chemoradiotherapy (CRT), male patients, and lower anastomotic level [4][5][6].…”