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What is the risk for a permanent stoma after low anterior resection of the rectum for cancer?: a six-year follow-up of a multicenter trial
Örebro University, School of Health and Medical Sciences.
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2011 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, no 1, p. 41-47Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of this study was to assess the risk for permanent stoma after low anterior resection of the rectum for cancer. METHODS: In a nationwide multicenter trial 234 patients undergoing low anterior resection of the rectum were randomly assigned to a group with defunctioning stomas (n = 116) or a group with no defunctioning stomas (n = 118). The median age was 68 years, 45% of the patients were women, 79% had preoperative radiotherapy, and 4% had International Union Against Cancer cancer stage IV. The patients were analyzed with regard to the presence of a permanent stoma, the type of stoma, the time point at which the stoma was constructed or considered as permanent, and the reasons for obtaining a permanent stoma. Median follow-up was 72 months (42-108). One patient with a defunctioning stoma who died within 30 days after the rectal resection was excluded from the analysis. RESULTS: During the study period 19% (45/233) of the patients obtained a permanent stoma: 25 received an end sigmoid stoma and 20 received a loop ileostomy. The end sigmoid stomas were constructed at a median of 22 months (1-71) after the low anterior resection of the rectum, and the loop ileostomies were considered as permanent at a median of 12.5 months (1-47) after the initial rectal resection. The reasons for loop ileostomy were metastatic disease (n = 6), unsatisfactory anorectal function (n = 6), deteriorated general medical condition (n = 3), new noncolorectal cancer (n = 2), patient refusal of further surgery (n = 2), and chronic constipation (n = 1). Reasons for end sigmoid stoma were unsatisfactory anorectal function (n = 22) and urgent surgery owing to anastomotic leakage (n = 3). The risk for permanent stomas in patients with symptomatic anastomotic leakage was 56% (25/45) compared with 11% (20/188) in those without symptomatic anastomotic leakage (P < .001). CONCLUSION: One patient of 5 ended up with a permanent stoma after low anterior resection of the rectum for cancer, and half of the patients with a permanent stoma had previous symptomatic anastomotic leakage.

Place, publisher, year, edition, pages
2011. Vol. 54, no 1, p. 41-47
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-20481DOI: 10.1007/DCR.0b013e3181fd2948ISI: 000285377500008OAI: oai:DiVA.org:oru-20481DiVA, id: diva2:461579
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Aspects of anastomotic leakage, anorectal function and defunctioning stoma in Low Anterior Resection of the rectum for cancer
Open this publication in new window or tab >>Aspects of anastomotic leakage, anorectal function and defunctioning stoma in Low Anterior Resection of the rectum for cancer
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 62
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 60
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-18840 (URN)978-91-7668-828-1 (ISBN)
Public defence
2011-11-18, Wilandersalen, Universitetssjukhuset i Örebro, Örebro, 09:00 (Swedish)
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Available from: 2011-09-29 Created: 2011-09-29 Last updated: 2017-10-17Bibliographically approved

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