When are defunctioning stomas in rectal cancer surgery really reversed? Results from a population-based single center experience.
OBJECTIVE
This study assessed the timing of reversal of defunctioning stoma following low anterior resection of the rectum for cancer and risk factors for a defunctioning stoma becoming permanent in patients who were not reversed.


METHODS
Patients who underwent low anterior resection with defunctioning stoma during a 12-year period were assessed with regard to timing of stoma reversal. Delayed reversal was defined as >4 months after low anterior resection. Patients with a defunctioning stoma that was never reversed were assessed regarding risk factors for permanent stoma.


RESULTS
A total of 134 patients were analyzed. Of 106 stoma reversals, 19% were reversed within 4 months of low anterior resection, while 81% were reversed later than 4 months. In 58% of these patients, the delay was to due to low medical priority given to this procedure. The other main reasons for delayed stoma reversal were nonsurgical complications (20%), symptomatic anastomotic leakage following low anterior resection (12%), and postoperative adjuvant chemotherapy (10%). Of all patients, 21% (28/134) ended up with a permanent stoma. Risk factors for a defunctioning stoma becoming permanent were stage IV cancer (P < 0.001) and symptomatic anastomotic leakage following low anterior resection (P < 0.001).


CONCLUSIONS
Four in five patients experienced a delayed stoma reversal, in a majority because of the low priority given to this surgical procedure.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
H
H
Floodeen
R
R
Lindgren
P
P
Matthiessen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
Rectal cancer; defunctioning stoma; low anterior resection of the rectum; permanent stoma; risk factors; stoma reversal; temporary stoma