title: Longterm -ostomy as a quality marker: Comparison of outcomes from a six year series of laparoscopic surgery in MRI defined low rectal cancer.
abstract: OBJECTIVE
  We propose long-term -ostomy rate following laparoscopic rectal cancer resection must be included as an overall quality indicator of treatment in conjunction with frequently reported and readily available end points.
  
  
  METHODS
  A database was collated prospectively of consecutive rectal cancer resections over a 6-year period. Recorded data included pre-operative MRI (tumour stage and height from the anal-verge), as well as demographics, treatment, local recurrence rate, survival and -ostomy rate as the primary outcome measure.
  
  
  RESULTS
  65 patients were identified and classified as low-rectal cancer if the tumour on MRI was < 6 cm from the anal verge or middle/upper-rectal cancer if between 6 and 15 cm from the anal-verge and below the peritoneal reflection. Permanent stoma rates including colostomies and non-reversed ileostomies were 31.7% for middle/upper rectal cancer; 62.5% for low-rectal cancer and an overall rate of 42.1% for all rectal cancers. For upper-rectal cancer the rates of local recurrence, predicted mortality, R0 resection and conversion were: 0%, 1.9%, 97.6% and 0% respectively. Corresponding figures for low-rectal cancer were: 4.2%, 2.7%, 95.8% and 0%. There were no significant differences for age, sex, predicted morbidity/mortality, survival, recurrence or leak rates between the groups.
  
  
  CONCLUSIONS
  Laparoscopic rectal cancer surgery has a comparable permanent -ostomy rate to open rectal cancer surgery. We benchmark 31.7% as the permanent -ostomy rate for upper-rectal cancer and 62.5% for low-rectal cancer following laparoscopic resection, in the context of 96.9% R0 resection and 0% conversion rate in a consecutive series of patients.
authors.affiliation: Queen Elizabeth Hospital, Gateshead Colorectal Unit, Sherriff Hill, Gateshead, United Kingdom.
authors.forename: Omotolani A O
authors.initials: OA
authors.lastname: Lewis
authors.affiliation: Queen Elizabeth Hospital, Gateshead Colorectal Unit, Sherriff Hill, Gateshead, United Kingdom.
authors.forename: Iain J D
authors.initials: IJ
authors.lastname: McCallum
authors.affiliation: Queen Elizabeth Hospital, Gateshead Colorectal Unit, Sherriff Hill, Gateshead, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: Dixon
authors.affiliation: Queen Elizabeth Hospital, Gateshead Colorectal Unit, Sherriff Hill, Gateshead, United Kingdom. Electronic address: mark.katory@ghnt.nhs.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Katory
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology; D003125:Colostomy / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000592:standards*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: -Ostomy rate; Laproscopic colorectal surgery; Quality indicators