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Cumulative Incidence of Permanent Stoma After Sphincter Preserving Low Anterior Resection of Mid and Low Rectal Cancer

Dinnewitzer, Adam M.D.1; Jäger, Tarkan M.D.1; Nawara, Clemens M.D.1; Buchner, Selina M.D.1; Wolfgang, Hitzl Ph.D.2; Öfner, Dietmar M.D.1

doi: 10.1097/DCR.0b013e31829ef472
Original Contributions: Colorectal/Anal Neoplasia

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:

© 2013 The American Society of Colon and Rectal Surgeons