title: Multivariate Analysis of Risk Factors Associated With the Nonreversal Ileostomy Following Sphincter-Preserving Surgery for Rectal Cancer.
abstract: OBJECTIVE
  A loop ileostomy is used to protect an anastomosis after anal sphincter-preserving surgery, especially in patients with low rectal cancer, but little information is available concerning risk factors associated with a nonreversal ileostomy. The purpose of this study was to identify risk factors of ileostomy nonreversibility after a sphincter-saving resection for rectal cancer.
  
  
  METHODS
  Six hundred seventy-nine (679) patients with rectal cancer who underwent sphincter-preserving surgery between January 2004 and December 2011 were evaluated retrospectively. Of the 679, 135 (19.9%) underwent a defunctioning loop ileostomy of temporary intent, and these patients were divided into two groups, that is, a reversal group (RG, 112 patients) and a nonreversal group (NRG, 23 patients) according to the reversibility of the ileostomy.
  
  
  RESULTS
  In 23 of the 135 rectal cancer patients (17.0%) that underwent a diverting ileostomy, stoma reversal was not possible for the following reasons; stage IV rectal cancer (11, 47.8%), poor tone of the anal sphincter (4, 17.4%), local recurrence (2, 8.7%), anastomotic leakage (1, 4.3%), radiation proctitis (1, 4.3%), and patient refusal (4, 17.4%). The independent risk factors of the nonreversal group were anastomotic leakage or fistula, stage IV cancer, local recurrence, and comorbidity.
  
  
  CONCLUSIONS
  Postoperative complications such as anastomotic leakage or fistula, advanced primary disease (stage IV), local recurrence and comorbidity were identified as risk factors of a nonreversal ileostomy. These factors should be considered when drafting prudential guidelines for ileostomy closure.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Kim
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Gil Jae
authors.initials: GJ
authors.lastname: Lee
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Won-Suk
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Jeong-Heum
authors.initials: JH
authors.lastname: Baek
keywords: Ileostomy; Rectal cancer; Sphincter-preserving surgery