title: Risk factors for permanent stoma after low anterior resection for rectal cancer.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital, 160 ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanamdo, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lim
authors.forename: Hun Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Kim
authors.forename: Jung Wook
authors.initials: JW
authors.lastname: Huh
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hyeong Rok
authors.initials: HR
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D018450:Disease Progression; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome