title: Cumulative incidence of permanent stoma after sphincter preserving low anterior resection of mid and low rectal cancer.
abstract: BACKGROUND
  Changes in the treatment of rectal cancer during the past decades have led to an increase in sphincter preservation with a consecutive decline in abdominoperineal resection rates.
  
  
  OBJECTIVE
  The aim of this study was to analyze the cumulative incidence of permanent stoma in patients undergoing sphincter-preserving resection of mid and low rectal cancer.
  
  
  METHODS
  This study is a retrospective analysis of prospectively collected data.
  
  
  METHODS
  This study was conducted at a tertiary referral cancer hospital.
  
  
  METHODS
  From 2003 to 2010, 125 patients with primary mid and low rectal cancer who underwent sphincter-preserving low anterior resection were included.
  
  
  METHODS
  The occurrence of a permanent stoma over time was investigated by using a Cox proportional hazards regression model and competing-risk models, with death as a competing risk. The risk factors were assessed by computing HRs and a Cox proportional hazards regression.
  
  
  RESULTS
  After a median follow-up time of 61 months (range, 22-113), 15 of 125 patients ended up with a permanent stoma, accounting for a 5-year cumulative incidence of 6% (95% CI, 4%-11%). The reasons for obtaining a permanent stoma were anastomotic leakage (60%, 9/15), intractable fecal incontinence (27%, 4/15), and local recurrence (13%, 2/15). The Cox proportional hazards regression identified anastomotic leakage (HR, 6.10; 95% CI, 2.23-16.71; p = 0.0004) and coloanal anastomosis (HR, 4.31; 95% CI, 1.49-12.47; p = 0.007) as statistically significant risk factors.
  
  
  CONCLUSIONS
  Because of the small number of events in this sample, further investigations with a larger number of patients are required. Fecal incontinence was assessed by patient self-reported data without the use of a validated score.
  
  
  CONCLUSIONS
  The 5-year cumulative incidence of a permanent stoma was 6%. Anastomotic leakage and coloanal anastomosis were identified as risk factors. These details should be considered before sphincter-preserving surgery.
authors.affiliation: 1 Department of Surgery, Paracelsus Medical University, Salzburg, Austria 2 Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Adam
authors.initials: A
authors.lastname: Dinnewitzer
authors.forename: Tarkan
authors.initials: T
authors.lastname: Jäger
authors.forename: Clemens
authors.initials: C
authors.lastname: Nawara
authors.forename: Selina
authors.initials: S
authors.lastname: Buchner
authors.forename: Hitzl
authors.initials: H
authors.lastname: Wolfgang
authors.forename: Dietmar
authors.initials: D
authors.lastname: Öfner
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D003106:Colon / Q000601:surgery*; D003125:Colostomy; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D059351:Organ Sparing Treatments; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D005472:Fluorouracil