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Sobrado LF, Nahas CSR, Marques CFS, Sobrado CW, Nahas SC. Pretreatment colostomy in patients with anal squamous cell carcinoma: Risk factors for a permanent stoma. J Surg Oncol 2022; 126:740-747. [PMID: 35639271 DOI: 10.1002/jso.26965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current standard of care for anal squamous cell carcinoma (SCC) is concurrent chemoradiation (CRT), which enables tumor eradication while preserving the anal sphincter. Patients with locally advanced tumors, however, may experience complications that preclude treatment before stoma creation. OBJECTIVE To evaluate the reversal rate of pretreatment stomas and the risk factors associated with nonreversal. METHODS This single-institution retrospective cohort study using a prospective database included patients diagnosed with anal SCC from January 2008 to December 2020 who required a stoma before curative CRT. RESULTS In total, 651 patients were identified; 65 required a stoma before chemoradiation due to obstruction (43.1%), rectovaginal fistula (20%), and perianal sepsis (36.9%). The stoma was reversed in nine patients after a mean follow-up of 35.8 months. Risk factors associated with a permanent stoma were perianal sepsis (p = 0.010), interruptions during radiotherapy for more than 7 days (p = 0.010), male sex (p = 0.013), poor performance status (Eastern Cooperative Oncology Group [ECOG] ≥ 2) (p = 0.023), large tumors (p = 0.045), and cisplatin-based chemotherapy (p = 0.047). CONCLUSIONS Pretreatment stomas are unlikely to be reversed, and risk factors for a permanent stoma are perianal sepsis, interruptions during radiotherapy for more than 7 days, male sex, poor performance status (ECOG ≥ 2), large tumors, and cisplatin-based chemotherapy.
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Affiliation(s)
- Lucas F Sobrado
- Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Caio S R Nahas
- Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos F S Marques
- Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos W Sobrado
- Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sergio C Nahas
- Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Gouvas N, Gourtsoyianni S, Kalogeridi MA, Sougklakos J, Vini L, Xynos E. Hellenic society of medical oncology (HESMO) guidelines for the management of anal cancer. Updates Surg 2020; 73:7-21. [PMID: 33231836 DOI: 10.1007/s13304-020-00923-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 01/01/2023]
Abstract
Despite considerable improvement in the management of anal cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centres in Greece and Cyprus. The aim was to elaborate a consensus on the multidisciplinary management of anal cancer, based on European guidelines (European Society of Medical Oncologists-ESMO), considering local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralisation, care by a multidisciplinary team (MDT) and adherence to guidelines are emphasised.
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Affiliation(s)
- Nikolaos Gouvas
- Colorectal Surgeon, Nicosia General Hospital, Medical School, Shacolas Educational Centre for Clinical Medicine, University of Cyprus, Palaios Dromos Lefkosias Lemesou No.215/6Aglantzia, 2029, Nicosia, Cyprus.
| | - Sophia Gourtsoyianni
- Abdominal Radiologist, "Aretaieion" Hospital, Faculty of Medicine, University of Athens, Athens, Greece
| | | | - John Sougklakos
- Medical Oncologist, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Louisa Vini
- Clinical Oncologist/Radiotherapist, "Iatriko" Hopsital of Athens, Athens, Greece
| | - Evangelos Xynos
- Colorectal Surgeon, Creta Inter-Clinic Hopsital, Heraklion, Greece
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Poynter LR, Raman R, Wegstapel H, Summers J, Lawes DA. The prevalence and fate of the defunctioning stoma in patients with anal cancer: a regional experience following the ACT II trial. Colorectal Dis 2017; 19:O407-O412. [PMID: 28834078 DOI: 10.1111/codi.13855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 06/10/2017] [Indexed: 02/08/2023]
Abstract
AIM UK guidance advises the creation of a defunctioning stoma for anal tumours infiltrating the vagina, impending obstruction or significant faecal incontinence. Other patients may be offered a defunctioning stoma at the discretion of the clinician. The purpose of this study was to establish the prevalence and fate of defunctioning stomas in a regional anal cancer service, with reference to the results from the recent ACT II trial. METHOD Oncological treatment was standardized as described in the ACT II trial. All patients from 2010 to 2013 inclusive were included. Collected data were correlated with both the IMRT guidelines and the outcomes of the ACT II trial. Kaplan-Meier survival analysis was applied to stoma-free survival to the end of the study period. RESULTS Seventy-six patients were identified during the study period, of whom 51% had a defunctioning stoma. Twenty were performed for anterior tumours without infiltration into the vagina (Group A), whilst 19 had a stoma for indications as set out by the guidelines (Group B). Stoma reversal was performed in 41% of patients, 13/20 in Group A and 3/19 in Group B. The median time to reversal was 11 months. Eleven deaths were recorded and six patients still had their stomas at time of death. Stoma-free survival was 74%. No new ano-vaginal fistulation occurred as a consequence of treatment. CONCLUSION The tumour features that are indications for defunctioning as advised by the UK IMRT guidelines are associated with a poorer overall outcome, and these stomas are less likely to be reversed. The majority of stomas, however, were formed for anterior tumours without infiltration into the vagina and were more likely to be successfully reversed.
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Affiliation(s)
- L R Poynter
- Department of Laparoscopic, General and Colorectal Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - R Raman
- The Kent Oncology Centre, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - H Wegstapel
- Department of Laparoscopic, General and Colorectal Surgery, Medway NHS Foundation Trust, Gillingham, UK
| | - J Summers
- The Kent Oncology Centre, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - D A Lawes
- Department of Laparoscopic, General and Colorectal Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
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Cacheux W, Koessler T, Puppa G, Fernandez E, Ho L, Dietrich PY, Zilli T, Allal AS, Roche B, Ris F, Roth A. Early closure of fistula using neo-adjuvant intra-arterial chemotherapy in locally advanced anal cancer. Dig Liver Dis 2017; 49:1262-1266. [PMID: 28935189 DOI: 10.1016/j.dld.2017.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Locally advanced anal cancer patients, especially with T4 disease and fistula, have a dismal prognosis. Neo-adjuvant intra-arterial chemotherapy before standard chemoradiation has been shown to be promising in this setting. AIMS We are reporting results from a larger patient population. METHODS From 2005 to 2015, 25 consecutive patients with locally advanced anal cancer, 18 of them fistulised, received intra-arterial chemotherapy. RESULTS Twenty-two of 25 patients (88%) had T4N0-3 disease and 3 (12%) T3N3. An objective tumour response was observed in 24 of 25 patients (96%): 24 partial responses and 1 with stable disease. Fistulas' complete closure was observed in 15 of 18 patients (83.3%). Following intra-arterial chemotherapy, 23 patients underwent chemoradiation. Twenty-one of 25 patients (84%) had a complete remission 6 months after treatment completion. Amongst 22 patients followed for 3 or more years, 18 of them (81%) are colostomy free at 3 years. Five-year overall survival is 75%. Most frequent grade 3-4 toxicity of IAC was neutropenia (25%). CONCLUSIONS Neo-adjuvant intra-arterial chemotherapy combined to chemoradiation resulted in a high rate of fistulas closure and long-term control of locally advanced anal cancer. This interesting approach in the treatment of fistulised anal cancer, needs a prospective study before being considered a new standard strategy.
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Affiliation(s)
- Wulfran Cacheux
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland.
| | - Thibaud Koessler
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Giacomo Puppa
- Department of Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Eugenio Fernandez
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Lisa Ho
- Department of Pathology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Thomas Zilli
- Department of Radiation-oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Abdelkarim Said Allal
- Department of Radiation-oncology, University Hospital of Fribourg, Fribourg, Switzerland
| | - Bruno Roche
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva Switzerland
| | - Frederic Ris
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva Switzerland
| | - Arnaud Roth
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
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Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, Moran B, Bower M, Alfa-Wali M, Adams R. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Anal Cancer. Colorectal Dis 2017; 19 Suppl 1:82-97. [PMID: 28632308 DOI: 10.1111/codi.13709] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Andrew Renehan
- University of Manchester and Christie Hospital, Manchester, UK
| | - John Scholefield
- University of Nottingham and Queens Medical Centre, Nottingham, UK
| | - Vicky Goh
- King's College and Guy's & St Thomas' Hospital, London, UK
| | | | - Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Mark Bower
- Imperial College and Chelsea & Westminster Hospital, London, UK
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
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Risk Factors Associated With Nonclosure of Defunctioning Stomas After Sphincter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis. Dis Colon Rectum 2017; 60:544-554. [PMID: 28383455 DOI: 10.1097/dcr.0000000000000819] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Some patients receiving defunctioning stomas will never undergo stoma reversal, but it is difficult to preoperatively predict which patients will be affected. OBJECTIVE The aim of this meta-analysis was to identify the risk factors associated with nonclosure of temporary stomas after sphincter-preserving low anterior resection for rectal cancer. DATA SOURCES We performed a comprehensive search of the PubMed, Embase, and Cochrane Central Library databases for all of the studies analyzing risk factors for nonclosure of defunctioning stomas. STUDY SELECTION We only included articles published in English in this meta-analysis. The inclusion criteria were as follows: 1) original article with extractable data, 2) studies including only defunctioning stomas created after low anterior resection for rectal cancer, 3) studies with nonclosure rather than delayed closure as the main end point, and 4) studies analyzing risk factors for nonclosure. INTERVENTION Defunctioning stomas were created after low anterior resection for rectal cancer. MAIN OUTCOME MEASURES Stoma nonclosure was the only end point, and it included nonclosure and permanent stoma creation after primary stoma closure. The Newcastle-Ottawa Scale was used to assess methodologic quality of the studies, and risk ratios and 95% CIs were used to assess risk factors. RESULTS Ten studies with 8568 patients were included. The nonclosure rate was 19% (95% CI, 13%-24%; p < 0.001; I= 96.2%). Three demographic factors were significantly associated with nonclosure: older age (risk ratio= 1.50 (95% CI, 1.12-2.02); p = 0.007; I= 39.3%), ASA score >2 (risk ratio = 1.66 (95% CI, 1.51-1.83); p < 0.001; I= 0%), and comorbidities (risk ratio = 1.58 (95% CI, 1.29-1.95); p < 0.001; I= 52.6%). Surgical complications (risk ratio = 1.89 (95% CI, 1.48-2.41); p < 0.001; I= 29.7%), postoperative anastomotic leakage (risk ratio = 3.39 (95% CI, 2.41-4.75); p < 0.001; I= 53.0%), stage IV tumor (risk ratio = 2.96 (95% CI, 1.73-5.09); p < 0.001; I= 88.1%), and local recurrence (risk ratio = 2.84 (95% CI, 2.11-3.83); p < 0.001; I= 6.8%) were strong clinical risk factors for nonclosure. Open surgery (risk ratio = 1.47 (95% CI, 1.01-2.15); p = 0.044; I= 63.6%) showed a borderline significant association with nonclosure. LIMITATIONS Data on some risk factors could not be pooled because of the low number of studies. There was conspicuous heterogeneity between the included studies, so the pooled data were not absolutely free of exaggeration or influence. CONCLUSIONS Older age, ASA score >2, comorbidities, open surgery, surgical complications, anastomotic leakage, stage IV tumor, and local recurrence are risk factors for nonclosure of defunctioning stomas after low anterior resection in patients with rectal cancer, whereas tumor height, radiotherapy, and chemotherapy are not. Patients with these risk factors should be informed preoperatively of the possibility of nonreversal, and joint decision-making is preferred.
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Bown E, Shah V, Sridhar T, Boyle K, Hemingway D, Yeung JM. Cancers of the anal canal: diagnosis, treatment and future strategies. Future Oncol 2015; 10:1427-41. [PMID: 25052753 DOI: 10.2217/fon.14.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anal cancer is an uncommon cancer; however, it is rising in incidence. There is confusion regarding nomenclature and the distinction between anal canal cancer and anal margin cancer. This article discusses the modern definition, etiology and staging of anal canal and anal margin cancers. Modern chemotherapy and radiotherapy regimens are discussed, in addition to modern imaging and radiotherapy techniques. Future preventative strategies and potential novel treatments are discussed.
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Affiliation(s)
- Emma Bown
- Department of Colorectal Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
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Glynne-Jones R, Kadalayil L, Meadows HM, Cunningham D, Samuel L, Geh JI, Lowdell C, James R, Beare S, Begum R, Ledermann JA, Sebag-Montefiore D. Tumour- and treatment-related colostomy rates following mitomycin C or cisplatin chemoradiation with or without maintenance chemotherapy in squamous cell carcinoma of the anus in the ACT II trial. Ann Oncol 2014; 25:1616-22. [PMID: 24827136 DOI: 10.1093/annonc/mdu188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma of the anus (SCCA) is highly sensitive to chemoradiation (CRT) which achieves good loco-regional control and preserves anal function. However, some patients require permanent stoma formation either as a result of surgery on relapse, poor anal function or treatment-related symptoms. Our aim was to determine patient, tumour and treatment-related colostomy rates following CRT and maintenance chemotherapy in the ACT II trial. PATIENTS AND METHODS The ACT II trial recruited 940 patients comparing 5FU-based CRT using cisplatin (CisP) or mitomycin C (MMC) with or without additional maintenance chemotherapy. We investigated the association between colostomy-free survival (CFS) and progression-free survival (PFS) with age, gender, T-stage, N-stage, treatment and baseline haemoglobin. RESULTS The median follow-up was 5.1 years (n = 884 evaluable/940); tumour site canal (84%), margin (14%); stage T1/T2 (52%), T3/T4 (46%); N+ (32%), N0 (62%). Twenty out of 118 (17%) colostomies fashioned before CRT were reversed within 8 months. One hundred and twelve patients had a post-treatment colostomy due to persistent disease (98) or morbidity (14). Fifty-two per cent (61/118) of all pre-treatment colostomies were never reversed. The 5-year CFS rates were 68% MMC/Maint, 70% CisP/Maint, 68% MMC/No-maint and 65% CisP/No-maint. CRT with CisP did not improve CFS when compared with MMC (hazard ratio: 1.04, 95% confidence interval: 0.82-1.31, P = 0.74). The 5-year CFS rates were higher for T1/T2 (79%) than T3/T4 (54%) tumours and higher for node-negative (72%) than node-positive (60%) patients. Significant predictors of CFS were gender, T-stage and haemoglobin, while treatment factors had no impact on outcome. Similar associations were found between PFS and tumour/treatment-related factors. CONCLUSIONS The majority (52%) of pre-treatment colostomies were never reversed. Neither CRT with 5FU/CisP nor maintenance chemotherapy impacted on CFS. The low risk of colostomy for late effects (1.7%) is likely to be associated with the modest total radiotherapy dose. The predictive factors for CFS were T-stage, gender and baseline haemoglobin. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN 26715889.
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Affiliation(s)
- R Glynne-Jones
- Department of Medical Oncology, Mount Vernon Centre for Cancer Treatment, Northwood
| | - L Kadalayil
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - H M Meadows
- Cancer Research UK and University College London Cancer Trials Centre, London
| | | | - L Samuel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen
| | - J I Geh
- Department of Oncology, Queen Elizabeth Hospital, Birmingham
| | - C Lowdell
- Department of Oncology, Imperial College Healthcare NHS Trust, London
| | - R James
- The Kent Cancer Centre, Tonbridge, Maidstone
| | - S Beare
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - R Begum
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - J A Ledermann
- Cancer Research UK and University College London Cancer Trials Centre, London
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Predictive factors for early and late local toxicities in anal cancer treated by radiotherapy in combination with or without chemotherapy. Dis Colon Rectum 2013; 56:1125-33. [PMID: 24022529 DOI: 10.1097/dcr.0b013e3182a226bd] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The treatment of anal cancer is based on concomitant radiotherapy and chemotherapy and is associated with a nonnegligible rate of local severe toxicities that can strongly impair the quality of life. OBJECTIVE A retrospective analysis was performed to screen the following factors as potential predictive factors for local skin and digestive toxicities, and as potential prognostic factors for cumulative colostomy incidence: sex, age, tumor size, clinical T and N stage, circumferential extension, invasion of anal margin, HIV status, type of chemotherapy, and type of radiotherapy and dose delivered. METHODS One hundred five patients in our database treated between January 2000 and February 2010 met the eligibility criteria. RESULTS Median follow-up was 54.1 months (range, 1-133). Early and late severe local toxicities occurred in 33 patients (31.4%) and 18 patients (17.1%). The 5-year cumulative rate of colostomy was 26.6%. Predictive factors for local severe early toxicities were as follows: clinical stage III/IV (p = 0.01), no brachytherapy boost (p = 0.003), and use of chemotherapy (p = 0.01). Only brachytherapy retained its independence in multivariate analysis (OR = 4.8 (1.4-16.3), p = 0.01). Human immunodeficiency virus positivity (p = 0.04) was the only predictive factor for late toxicities in univariate analysis; it was linked independently to the occurrence of ulcer (OR = 0.1 (0.01-0.66), p = 0.01). Tumor size ≥4 cm (p < 0.001) and occurrence of grade 2 to 3 ulcers (p < 0.001) were correlated with greater cumulative colostomy incidence. CONCLUSIONS In this cohort, nonuse of brachytherapy was an independent predictive factor for local acute toxicity. Human immunodeficiency virus positivity was the only predictive factor for local late toxicities and strongly influenced the onset of ulcer.
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Glynne-Jones R, Beare S, Begum R, Kadalayil L. Capturing Data on Colostomy Formation in Anal Cancer. J Clin Oncol 2013; 31:164. [DOI: 10.1200/jco.2012.44.2293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rob Glynne-Jones
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Sandy Beare
- Cancer Research United Kingdom and University College London Cancer Trials Centre, London, United Kingdom
| | - Rubina Begum
- Cancer Research United Kingdom and University College London Cancer Trials Centre, London, United Kingdom
| | - Latha Kadalayil
- Cancer Research United Kingdom and University College London Cancer Trials Centre, London, United Kingdom
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Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Risk factors for permanent stoma after low anterior resection for rectal cancer. Langenbecks Arch Surg 2012; 398:259-64. [PMID: 23224628 DOI: 10.1007/s00423-012-1038-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 11/27/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE This study evaluated the risk factors influencing permanent stoma after curative resection of rectal cancer and compared the long-term survival of patients according to the stoma state. METHODS From January 2004 to December 2010, 895 consecutive rectal cancer patients with histological-confirmed adenocarcinoma who received low anterior resection with curative intent at the Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, were evaluated retrospectively. Patient demographics, times of stoma reversal, and number/reason of permanent stoma were evaluated. RESULTS Three hundred fifteen patients (35.2 %) had a diverting stoma of temporary intent among 895 rectal adenocarcinoma patients. Loop ileostomy was performed in 271 patients (86.0 %). A total of 256 (81.3 %) of 315 stoma patients received stoma closure. The mean period between primary surgery and stoma closure was 5.6 months (range, 1-44 months). Seventy-three patients (23.2 %) were confirmed with permanent stoma. Multivariate analysis showed stage IV (hazard ratio (HR), 3.380; 95 % confidence interval (CI), 1.192-18.023; p = 0.027), anastomosis-related complication (HR, 3.299; 95 % CI, 1.397-7.787; p = 0.006), colostomy type (HR, 7.276, 95 % CI, 2.454-21.574; p = 0.000), systemic metastasis (HR, 2.698; 95 % CI, 1.1.288-5.653; p = 0.009), and local recurrence (HR, 4.231; 95 % CI, 1.724-10.383; p = 0.002) were independent risk factors for permanent stoma. CONCLUSIONS On postoperative follow-up, in patients with anastomotic complication, tumor progression with local recurrences and systemic metastasis may cause permanent stoma.
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Affiliation(s)
- Sang Woo Lim
- Department of Surgery, Chonnam National University Hwasun Hospital, 160 ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanamdo, Korea
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