gms | German Medical Science

Introduction: Substantial changes in the treatment of rectal cancer during the last decades have led to an increase in sphincter preservation with a consecutive fall in abdominoperineal resection rates. The aim of our study was to determine the risk for a permanent stoma (PST) in patients undergoing sphincter-preserving low anterior resection (SPLAR) of mid-to-low rectal cancer in a long-term follow-up.

Material and methods: A retrospective cohort study was conducted of 125 patients with primary mid-to-low rectal cancer operated with SPLAR in a single institution. Data were collected prospectively within a proprietary colorectal cancer database. The cumulative probability for a PST was estimated by the Kaplan-Meier method. Univariate and multivariate logistic regression models were used to identify risk factors.

Results: The median follow-up period was 61 months (range 22 - 113). Fifteen of 125 (12%) patients ended up with a PST. In 11 cases (73%) an end colostomy, in 3 patients (20%) a loop colostomy was performed and one primary loop ileostomy was considered as permanent. The reasons for obtaining a PST were anastomosis related complications 60% (9/15), intractable fecal incontinence 27% (4/15), and local recurrence 13% (2/15). Multivariate logistic regression analysis identified anastomotic leakage (OR = 7.5; 95% CI, 2.0 - 27.3; P = 0.002), neoadjuvant radiochemotherapy (OR = 6.6; 95% CI, 1.2 - 36.1; P = 0.03) and colonanal anastomosis (OR = 5.1; 95% CI, 1.2 - 20.5; P = 0.02) as independent risk factors.

Conclusion: Our results show that, in our population, the five-year cumulative probability for a PST after SPLAR is 13.4%. In 87% surgery related complications were responsible for a PST. These details should be considered to weigh up the pros and cons of sphincter preservation in mid-to-low rectal cancer.