What is the risk of permanent stoma beyond 5 years after low anterior resection for rectal cancer? A 15‐year follow‐up of a randomized trial. (24th October 2020)

• Record Type: Journal Article
• Authors: Gadan, S.; Floodeen, H.; Lindgren, R.; Rutegård, M.; Matthiessen, P.
• Is Part Of: Colorectal disease. Volume 22:Number 12(2020)
• Page Start: 2098
• Page End: 2104
• Publication Date: 2020-10-24
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15364
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: Low anterior resection of the rectum for cancer (LAR) entails a risk of symptomatic anastomotic leakage as well as impaired anorectal function, both of which may eventually result in the need for a permanent stoma (PS). The aim was to investigate the incidence of and risk factors for PS beyond 5 years following LAR. Methods: Patients undergoing LAR and included in a multicentre trial with randomization to defunctioning stoma or not were followed for a median of 15 years. The reasons for a PS up to 5 years (PS ≤ 5 years) and beyond 5 years (PS > 5 years) were identified and compared. Risk factors for PS were analysed. Results: Of all patients, 25% (57/232) had a PS. PS ≤ 5 years occurred in 19% (44/232) at a median of 12.5 months and PS > 5 years in 6% (13/232) at a median of 118 months following LAR. The main reason for PS ≤ 5 years was impaired anorectal function in 55% (24/44) and the main reason for PS > 5 years was pelvic sepsis related to the colorectal anastomosis in 46% (6/13). The major risk factor for PS was symptomatic anastomotic leakage, which occurred in 56% (32/57) of patients with PS and 10% (17/175) of patients without PS ( P < 0.001). Conclusion: One‐fourth of the patients who ended up with a PS had it fashioned beyond 5 years at a median of 10 years following LAR. Symptomatic anastomotic leakage was the major risk factor for PS, and impaired anorectal function was the main overall reason for a PS.