title: The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer.
abstract: OBJECTIVE
  The long-term risk of definitive stoma after sphincter-saving resection (SSR) for rectal cancer is underestimated and has never been reported for ultralow conservative surgery. We report the 10-year risk of definitive stoma after SSR for low rectal cancer.
  
  
  METHODS
  From 1994 to 2008, patients with low rectal cancer who were suitable for SSR were analysed retrospectively. Patients were divided into the following four groups: low colorectal anastomosis (LCRA); coloanal anastomosis (CAA); partial intersphincteric resection (pISR); and total intersphincteric resection (tISR). The end-point was the risk of a definitive stoma according to the type of anastomosis.
  
  
  RESULTS
  During the study period, 297 patients had SSR for low rectal cancer. The incidence of definitive stoma increased from 11% at 1 year to 22% at 10 years. The reasons were no closure of the loop ileostomy (4.7%), anastomotic morbidity (6.5%), anal incontinence (8%) and local recurrence (5.2%). The risk of definitive stoma was not influenced by type of surgery: 26% vs 18% vs 18% vs 19% (P = 0.578) for LCRA, CAA, pISR and tISR, respectively. Independent risk factors for definitive stoma were age > 65 years and surgical morbidity.
  
  
  CONCLUSIONS
  The risk of a definitive stoma after SSR increased two-fold between 1 and 10 years after surgery, from 11% to 22%. Ultralow conservative surgery (pISR and tISR) did not increase the risk of definitive stoma compared with conventional CAA or LCRA.
authors.affiliation: Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.|Université Bordeaux Segalen, Bordeaux, France.
authors.forename: B
authors.initials: B
authors.lastname: Celerier
authors.affiliation: Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.|Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Q
authors.initials: Q
authors.lastname: Denost
authors.affiliation: Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.|Université Bordeaux Segalen, Bordeaux, France.
authors.forename: B
authors.initials: B
authors.lastname: Van Geluwe
authors.affiliation: Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.|Université Bordeaux Segalen, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Pontallier
authors.affiliation: Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.|Université Bordeaux Segalen, Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Rullier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D057868:Anastomotic Leak / Q000453:epidemiology*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003125:Colostomy / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D059351:Organ Sparing Treatments; D011878:Radiotherapy / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Definitive stoma; low rectal cancer; sphincter-saving resection