Risk of Permanent Stoma after Sphincter-Saving Resection for Mid-to-Lower Rectal Cancer

Background: Due to the technical progress with the advent of mechanical stapling devices, introduction of total mesorectal excision and long course neoadjuvant radiochemotherapy in the treatment of rectal cancer over the last decades, the number of sphincter-saving resection (SSR) in rectal cancer increased constantly. Despite the avoidance of a permanent stoma for patients with rectal cancer, some patients end up with a permanent stoma for different reasons. The aim of our study was to evaluate the risk of a permanent stoma after curative intended SSR of mid-to-lower rectal cancer.

Methods: In a retrospective cohort study we analyzed all patients (n=830) with colorectal cancer from October 2002 to October 2010 using the institutional colorectal database. All patients after SSR of mid-to-lower rectal cancer were identified and included in the analysis.

Results: We identified 126 patients (female 40%) with a median age of 63 (range 41–90) at risk. A permanent stoma after SSR was performed in 11 (9%) cases. The overall risk for a permanent stoma with a median follow-up of 36 months (range 0–93) was 7.6% (11/126). Causes for perfoming a permanent stoma were anastomosis insufficiency (5), sphincter weakness (4) and others (2).

Conclusion: After performing a SSR of rectal cancer with an anastomosis the risk of ending up with a permanent stoma is 8%. This should be discussed with the patient as an integral part of the informed decision progress before surgery.