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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
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
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2011 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, no 1, 41-47 p.Article 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
American Society of Colon and Rectal Surgeons , 2011. Vol. 54, no 1, 41-47 p.
Keyword [en]
Rectal cancer, Defunctioning stoma, Low anterior resection, Loop ileostomy, Temporary stoma
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URN: urn:nbn:se:umu:diva-57214DOI: 10.1007/DCR.0b013e3181fd2948PubMedID: 21160312OAI: diva2:540515
Available from: 2012-07-10 Created: 2012-07-10 Last updated: 2012-08-16Bibliographically approved

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