Background: The aim of the present study was to identify the risk factors and patient characteristics associated with permanent stomas after sphincter-saving resection for rectal cancer.
Method: Between 2000 and 2007, 2,362 patients underwent sphincter-saving surgery [low anterior resection or ultra-low anterior resection (uLAR)] for rectal cancer. These patients were divided into two groups: 71 patients with permanent stomas and 2,291 patients without permanent stomas after rectal cancer surgery.
Results: Of the 71 permanent stomas (3 % of the patients), 34 (48 %) were ileostomies, 11 (15 %) were loop colostomies, 10 (14 %) were treated by Hartmann's operation, and 16 (23 %) were treated by abdominoperineal resection. Diverting stomas were created in 364 patients; 3 % (n = 11) of them could not be reversed due to anastomosis-related complications. Permanent stomas were constructed at a median of 20 months after sphincter-saving surgery for rectal cancer. The main causes of permanent stomas were local recurrence (n = 27), anastomotic leakage (n = 12), fistula (n = 9), and anastomosis site stricture (n = 7). The main causes of early permanent stomas (<1 year) were anastomosis-related complications, whereas for late permanent stomas (≥1 year), the main cause was local cancer recurrence. The independent risk factors for permanent stomas were local recurrence, postoperative pelvic sepsis, male gender of the patient, the uLAR operation type, and perioperative radiation therapy.
Conclusions: In a high-volume surgical center, sphincter-saving surgery for rectal cancer is associated with a low incidence of permanent stoma.