BACKGROUND: Changes in the treatment of rectal cancer during the past decades have led to an increase in sphincter preservation with a consecutive decline in abdominoperineal resection rates.
OBJECTIVE: The aim of this study was to analyze the cumulative incidence of permanent stoma in patients undergoing sphincter-preserving resection of mid and low rectal cancer.
DESIGN: This study is a retrospective analysis of prospectively collected data.
SETTINGS: This study was conducted at a tertiary referral cancer hospital.
PATIENTS: From 2003 to 2010, 125 patients with primary mid and low rectal cancer who underwent sphincter-preserving low anterior resection were included.
MAIN OUTCOME MEASURES: The occurrence of a permanent stoma over time was investigated by using a Cox proportional hazards regression model and competing-risk models, with death as a competing risk. The risk factors were assessed by computing HRs and a Cox proportional hazards regression.
RESULTS: After a median follow-up time of 61 months (range, 22–113), 15 of 125 patients ended up with a permanent stoma, accounting for a 5-year cumulative incidence of 6% (95% CI, 4%–11%). The reasons for obtaining a permanent stoma were anastomotic leakage (60%, 9/15), intractable fecal incontinence (27%, 4/15), and local recurrence (13%, 2/15). The Cox proportional hazards regression identified anastomotic leakage (HR, 6.10; 95% CI, 2.23–16.71; p = 0.0004) and coloanal anastomosis (HR, 4.31; 95% CI, 1.49–12.47; p = 0.007) as statistically significant risk factors.
LIMITATIONS: Because of the small number of events in this sample, further investigations with a larger number of patients are required. Fecal incontinence was assessed by patient self-reported data without the use of a validated score.
CONCLUSION: The 5-year cumulative incidence of a permanent stoma was 6%. Anastomotic leakage and coloanal anastomosis were identified as risk factors. These details should be considered before sphincter-preserving surgery.
1 Department of Surgery, Paracelsus Medical University, Salzburg, Austria
2 Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria
Financial Disclosures: None reported.
Correspondence: Adam Dinnewitzer, M.D., Department of Surgery, Paracelsus Medical University, Muellner Hauptstraße 48, A-5020 Salzburg, Austria. E-mail: firstname.lastname@example.org