Elsevier

Surgery

Volume 159, Issue 3, March 2016, Pages 721-727
Surgery

Colon and Rectal Surgery
Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy

https://doi.org/10.1016/j.surg.2015.09.011Get rights and content

Background

Although creation of a temporary diverting ileostomy during resection for rectal cancer surgery is used widely to decrease the risk of anastomotic leakage, a frequent outcome is maintenance of this “temporary” ileostomy as a permanent stoma (PS). Our aim was to assess the incidence of PS and identify potential risk factors.

Methods

This observational study included patients who underwent rectal cancer surgery with temporary ileostomy with curative intent between January 2001 and December 2008. Patient demographics, perioperative outcomes, and complications were analyzed. Incidences of primary PS (present at the endpoint of the study without stoma reversal) and secondary PS (created after closure of the primary stoma) were investigated. Univariate and multivariate analyses were conducted to determine risk factors.

Results

Of 673 enrolled patients, 64 (9.5%) developed PS, including 23 cases of primary PS and 41 of secondary PS. The causes of primary PS were systemic metastases (n = 12), anastomosis stricture (n = 4), poor general condition (n = 3), patient refusal (n = 2), and other (n = 2). The causes of secondary PS were local recurrence (n = 12), uncontrolled pelvic abscess (n = 11), unsatisfactory anorectal function (n = 10), anastomosis stricture (n = 6), and other (n = 2). In multivariate analysis, anastomosis leakage (P < .001), involvement of the circumferential resection margin (P = .013), and stage III tumor (P = .001) were independent risk factors for PS.

Conclusion

Patients with advanced cancer or anastomotic leakage are at high risk of PS after temporary ileostomy. Surgeons should be aware and patients should be informed of the possibility of PS formation.

Section snippets

Patients and methods

Patients who underwent rectal cancer surgery with temporary ileostomy with curative intent at National Cancer Center, Korea, between January 2001 and December 2008 were reviewed retrospectively. The inclusion criteria were (1) histologically proven rectal adenocarcinoma situated ≤15 cm from the anal verge, (2) no previous or concurrent malignancy, and (3) no evidence of distant metastasis at the time of operation. Patients with histologic findings other than adenocarcinoma, familial adenomatous

Results

A total of 2,014 patients underwent rectal cancer surgery during the study period. Based on the inclusion and exclusion criteria, 673 patients were identified and analyzed in the present study as having a “temporary ileostomy.” The median follow-up period was 53 months (range, 12–120). During the follow-up period, 64 of the 673 patients (9.5%) developed a PS, including 23 patients with primary PS and 41 patients who underwent secondary PS after recreation of another stoma (ileostomy or

Discussion

Several studies and metaanalyses have demonstrated the benefits of defunctioning stoma for decreasing the risks and morbidity of anastomotic leakage and reoperation and recommended the creation of stoma after sphincter-preserving very low anterior resection for rectal cancer.3, 4, 5, 6, 12 The overall leakage rate of 3.9% (26/673) obtained in the present study was within the previously reported leakage rate range of 3–21%. This favorable result is likely a consequence of the creation of a

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    Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

    Sources of financial support: NCC1510160-1.

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