ObjectiveTo identify the risk factors for permanent stoma following low anterior resection with a temporary ileostomy for rectal cancer.
MethodsA total of 315 consecutive rectal cancer patients were retrospectively reviewed. The associations between the type of stoma and clinicopathological variables were analyzed using chi-square tests. The predictive factors for permanent stoma were analyzed using the Kaplan-Meier survival curve. Multivariate analyses were also performed by the Cox proportional hazards model.
ResultsAmong 315 patients, 127 cases underwent temporary stoma, and diverting ileostomy and colostomy were performed on 116 and 11 patients respectively. Among the ileostomy cases, 94 underwent stoma reversal, and the median interval from initial surgery to stoma closure was 6.3 months. Three patients eventually underwent stoma recreation, and hence, 25 patients had permanent stoma. The stoma non-reversal rate was 14% at 2nd year after surgery. Lymph node metastasis, intersphincteric resection and hand sewn anastomosis were associated with permanent stoma on univariate analysis, but not on multivariate analysis. Based on the findings of multivariate, distant metastasis, depth of invasion and preoperative chemoradiotherapy were the risk factors of preventing stoma closure.
ConclusionThe most common factors preventing stoma closure included distant metastasis and local recurrence. However, distance from anal verge, the number of lymph node metastasis and type of resection had little effect on the stoma closure.
Chinese Journal of Experimental Surgery
Middle and low rectal cancer