title: 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.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Örebro University Hospital, Örebro, Sweden. rickard.lindgren@orebroll.se
authors.forename: Rickard
authors.initials: R
authors.lastname: Lindgren
authors.forename: Olof
authors.initials: O
authors.lastname: Hallböök
authors.forename: Jörgen
authors.initials: J
authors.lastname: Rutegård
authors.forename: Rune
authors.initials: R
authors.lastname: Sjödahl
authors.forename: Peter
authors.initials: P
authors.lastname: Matthiessen
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D016009:Chi-Square Distribution; D003125:Colostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012306:Risk; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D016896:Treatment Outcome