title: Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?
abstract: OBJECTIVE
  For low-lying rectal cancers, proximal diversion can reduce anastomotic leak after sphincter-preserving surgery; however, evidence suggests that such temporary diversions are often not reversed. We aimed to evaluate nonreversal and delayed stoma reversal in elderly patients undergoing low anterior resection (LAR).
  
  
  METHODS
  SEER-Medicare-linked analysis from 1991-2007.
  
  
  METHODS
  A total of 1179 primary stage I-III rectal cancer patients over age 66 who underwent LAR with synchronous diverting stoma.
  
  
  METHODS
  (1) Stoma creation and reversal rates; (2) time to reversal; (3) characteristics associated with reversal and shorter time to reversal.
  
  
  RESULTS
  Within 18 mo of LAR, 51% of patients (603/1179) underwent stoma reversal. Stoma reversal was associated with age <80 y (P < 0.0001), male sex (P = 0.018), fewer comorbidities (P = 0.017), higher income (quartile 4 versus 1; P = 0.002), early tumor stage (1 versus 3; P < 0.001), neoadjuvant radiation (P < 0.0001), rectal tumor location (versus rectosigmoid; P = 0.001), more recent diagnosis (P = 0.021), and shorter length of stay on LAR admission (P = 0.021). Median time to reversal was 126 d (interquartile range: 79-249). Longer time to reversal was associated with older age (P = 0.031), presence of comorbidities (P = 0.014), more advanced tumor stage (P = 0.007), positive lymph nodes (P = 0.009), receipt of adjuvant radiation therapy (P = 0.008), more recent diagnosis (P = 0.004), and longer length of stay on LAR admission (P < 0.0001).
  
  
  CONCLUSIONS
  Half of elderly rectal cancer patients who undergo LAR with temporary stoma have not undergone stoma reversal by 18 mo. Identifiable risk factors predict both nonreversal and longer time to reversal. These results help inform preoperative discussions and promote realistic expectations for elderly rectal cancer patients.
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin 53792-3284, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Dodgion
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Yue-Yung
authors.initials: YY
authors.lastname: Hu
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Breen
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program; D054047:Surgical Stomas / Q000706:statistics & numerical data*