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Does a Defunctioning Stoma Impair Anorectal Function After Low Anterior Resection of the Rectum for Cancer?: A 12-Year Follow-up of a Randomized Multicenter Trial
Örebro University, School of Medical Sciences. Colorectal Unit, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Medical Sciences. Colorectal Unit, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Orebro Univ Hosp, Dept Surg, Colorectal Unit, Orebro, Sweden..
Colorectal Unit, Department of Surgery, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
2017 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 60, no 8, 800-806 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anorectal function after low anterior resection of the rectum for cancer is often impaired, and long-term outcome has not frequently been reported.

OBJECTIVE: We evaluated anorectal function 12 years after rectal resection with regard to whether patients had a defunctioning temporary stoma at the initial rectal resection.

DESIGN: An exploratory cross-sectional investigation of a previously randomized study population.

SETTINGS: Twenty-one Swedish hospitals performing rectal cancer surgery during a 5-year period participated in the trial.

PATIENTS: Patients operated on with low anterior resection for cancer were included.

INTERVENTIONS: Patients were randomly assigned to receive or not receive a temporary defunctioning stoma.

MAIN OUTCOME MEASURES: We evaluated anorectal function 12 years after low anterior resection in patients who were initially randomly assigned to temporary stoma or not, by means of using the low anterior resection syndrome score questionnaire, which assesses incontinence for flatus, incontinence for liquid stools, defecation frequency, clustering, and urgency. Self-perceived health status was evaluated by the EQ-5D-3L questionnaire.

RESULTS: Eighty-nine percent (87/ 98) of the patients responded to the questionnaires, including 46 with and 41 without an initial temporary stoma. Patient demography was comparable between the groups. No differences regarding major, minor, and no low anterior resection syndrome categories were found between the groups. The stoma group had increased incontinence for flatus (p = 0.03) and liquid stools (p = 0.005) and worse overall low anterior resection syndrome score (p = 0.04) but no differences regarding frequency, clustering, and urgency.

LIMITATIONS: The study was limited by its sample size (n = 98) based on a previously randomized trial population (n = 234).

CONCLUSIONS: After low anterior resection for cancer, the incidence of the categories major, minor, and no low anterior resection syndrome were comparable in the stoma and the no-stoma groups. Incontinence for flatus and liquid stools was more commonly reported by patients who were randomly assigned to temporary stoma, as compared with those without, which may indicate an association between temporary stoma and impaired anorectal function.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017. Vol. 60, no 8, 800-806 p.
Keyword [en]
Anorectal function, Defunctioning stoma, Low anterior resection, Low anterior resection syndrome score, Rectal cancer
National Category
Gastroenterology and Hepatology Surgery
Identifiers
URN: urn:nbn:se:oru:diva-59306DOI: 10.1097/DCR.0000000000000818ISI: 000405418100010PubMedID: 28682965Scopus ID: 2-s2.0-85024847647OAI: oai:DiVA.org:oru-59306DiVA: diva2:1136164
Available from: 2017-08-25 Created: 2017-08-25 Last updated: 2017-10-24Bibliographically approved

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Floodeen, HannahLindgren, Rickard

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