title: Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure.
abstract: OBJECTIVE
  The adoption of the total mesorectum excision technique and circular stapler devices has enabled the performance of ultralow colorectal anastomosis in rectal cancer surgery. However, rupture of the anastomosis still usually leads to a permanent stoma. The aim of this study was to analyze the cumulative failure rate and risk factors associated with reversal of colorectal or coloanal anastomosis after sphincter-saving surgery for rectal cancer, using standardized surgical regimen with the routine use of covering stoma. Our secondary interest was the feasibilities of redo surgery after failure.
  
  
  METHODS
  This was a retrospective study with 579 consecutive rectal cancer patients operated on at Helsinki University Hospital, Helsinki, Finland during 2005-2011. Data were collected from patient records. After exclusions, 273 consecutive patients treated with a low anterior resection with a protective stoma were included.
  
  
  RESULTS
  In total, 23 out of 271 (8.5 %) of the colorectal/coloanal anastomoses were converted to a permanent stoma. In five patients (1.8 %), the covering stoma was not closed. The permanent stoma rate was thus 28 out of 271 (10.3 %). The risk factors associated with failure were the tumor distance from the anal verge (p = 0.03), coloanal anastomosis (p = 0.003), early anastomotic complication (p < 0.001), anastomotic fistula (p < 0.001), anal incontinence (p = 0.05), and local recurrence (p < 0.001).
  
  
  CONCLUSIONS
  Our standardized surgical regimen with a covering stoma in low anterior resection for rectal cancer resulted in a minor anastomosis failure rate and a low risk of permanent stoma.
authors.affiliation: Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland. minna.rasanen@hus.fi.|University of Helsinki, Helsinki, Finland. minna.rasanen@hus.fi.
authors.forename: Minna
authors.initials: M
authors.lastname: Räsänen
authors.affiliation: Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland. laura.renkonen-sinisalo@hus.fi.|Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland. laura.renkonen-sinisalo@hus.fi.
authors.forename: Laura
authors.initials: L
authors.lastname: Renkonen-Sinisalo
authors.affiliation: Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland. monika.carpelan-holmstrom@hus.fi.
authors.forename: Monika
authors.initials: M
authors.lastname: Carpelan-Holmström
authors.affiliation: Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland. anna.lepisto@hus.fi.
authors.forename: Anna
authors.initials: A
authors.lastname: Lepistö
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003106:Colon / Q000601:surgery*; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012003:Rectal Fistula / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling; D054047:Surgical Stomas; D017211:Treatment Failure; D055815:Young Adult
keywords: Anastomotic failure; Colorectal/coloanal anastomosis; Covering stoma; Rectal cancer