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Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

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Acknowledgments

The authors thank research secretary Tuula Lehtinen for her expertise and MD, PhD Ilkka Helanterä and DSc Harri Mustonen for aid in statistical analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland

    Minna Räsänen, Laura Renkonen-Sinisalo, Monika Carpelan-Holmström & Anna Lepistö

  2. University of Helsinki, Helsinki, Finland

    Minna Räsänen

  3. Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland

    Laura Renkonen-Sinisalo

Authors
  1. Minna Räsänen
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  2. Laura Renkonen-Sinisalo
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  3. Monika Carpelan-Holmström
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Correspondence to Minna Räsänen.

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Räsänen, M., Renkonen-Sinisalo, L., Carpelan-Holmström, M. et al. Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure. Int J Colorectal Dis 30, 1323–1328 (2015). https://doi.org/10.1007/s00384-015-2291-x

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  • DOI: https://doi.org/10.1007/s00384-015-2291-x

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