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- Publisher Website: 10.1007/s00268-017-4090-8
- Scopus: eid_2-s2.0-85020513410
- PMID: 28620675
- WOS: WOS:000413114900033
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Article: Sphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma
Title | Sphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma |
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Authors | |
Issue Date | 2017 |
Publisher | Springer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/ |
Citation | World Journal of Surgery, 2017, v. 41 n. 11, p. 2912-2922 How to Cite? |
Abstract | Background: Advances in surgical techniques and paradigm changes in rectal cancer treatment have led to a drastic decline in the abdominoperineal resection rate, and sphincter-preserving operation is possible in distal rectal cancer. Objective: The aim of this study is to evaluate the long-term incidence of permanent stoma after sphincter-preserving surgery for low rectal cancer and its corresponding risk factors. Method: From 2000 to 2014, patients who underwent sphincter-preserving low anterior resection for low rectal cancer (within 5 cm from the anal verge) were included. The occurrence of permanent stoma over time and its risk factors were investigated by using a Cox proportional hazards regression model. Results: This study included 194 patients who underwent ultra-low anterior resection for distal rectal cancer, and the median follow-up period was 77 months for the surviving patients. Forty-six (23.7%) patients required a permanent stoma eventfully. Anastomotic-related complications and disease progression were the main reasons for permanent stoma. Clinical anastomotic leakage (HR 5.72; 95% CI 2.31–14.12; p < 0.001) and neoadjuvant chemoradiation (HR 2.34; 95% CI 1.12–4.90; p = 0.024) were predictors for permanent primary stoma. Local recurrence (HR 16.09; 95% CI 5.88–44.03; p < 0.001) and T4 disease (HR 11.28; 95% CI 2.99–42.49; p < 0.001) were predictors for permanent secondary stoma. The 5- and 10-year cumulative incidence for permanent stoma was 24.1 and 28.0%, respectively. Conclusion: Advanced disease, prior chemoradiation, anastomotic leakage and local recurrence predispose patients to permanent stoma should be taken into consideration when contemplating sphincter-preserving surgery. © 2017, Société Internationale de Chirurgie. |
Persistent Identifier | http://hdl.handle.net/10722/243827 |
ISSN | 2023 Impact Factor: 2.3 2023 SCImago Journal Rankings: 0.772 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Mak, JCK | - |
dc.contributor.author | Foo, CC | - |
dc.contributor.author | Wei, R | - |
dc.contributor.author | Law, WL | - |
dc.date.accessioned | 2017-08-25T03:00:01Z | - |
dc.date.available | 2017-08-25T03:00:01Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | World Journal of Surgery, 2017, v. 41 n. 11, p. 2912-2922 | - |
dc.identifier.issn | 0364-2313 | - |
dc.identifier.uri | http://hdl.handle.net/10722/243827 | - |
dc.description.abstract | Background: Advances in surgical techniques and paradigm changes in rectal cancer treatment have led to a drastic decline in the abdominoperineal resection rate, and sphincter-preserving operation is possible in distal rectal cancer. Objective: The aim of this study is to evaluate the long-term incidence of permanent stoma after sphincter-preserving surgery for low rectal cancer and its corresponding risk factors. Method: From 2000 to 2014, patients who underwent sphincter-preserving low anterior resection for low rectal cancer (within 5 cm from the anal verge) were included. The occurrence of permanent stoma over time and its risk factors were investigated by using a Cox proportional hazards regression model. Results: This study included 194 patients who underwent ultra-low anterior resection for distal rectal cancer, and the median follow-up period was 77 months for the surviving patients. Forty-six (23.7%) patients required a permanent stoma eventfully. Anastomotic-related complications and disease progression were the main reasons for permanent stoma. Clinical anastomotic leakage (HR 5.72; 95% CI 2.31–14.12; p < 0.001) and neoadjuvant chemoradiation (HR 2.34; 95% CI 1.12–4.90; p = 0.024) were predictors for permanent primary stoma. Local recurrence (HR 16.09; 95% CI 5.88–44.03; p < 0.001) and T4 disease (HR 11.28; 95% CI 2.99–42.49; p < 0.001) were predictors for permanent secondary stoma. The 5- and 10-year cumulative incidence for permanent stoma was 24.1 and 28.0%, respectively. Conclusion: Advanced disease, prior chemoradiation, anastomotic leakage and local recurrence predispose patients to permanent stoma should be taken into consideration when contemplating sphincter-preserving surgery. © 2017, Société Internationale de Chirurgie. | - |
dc.language | eng | - |
dc.publisher | Springer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/ | - |
dc.relation.ispartof | World Journal of Surgery | - |
dc.rights | The final publication is available at Springer via http://dx.doi.org/[insert DOI] | - |
dc.title | Sphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma | - |
dc.type | Article | - |
dc.identifier.email | Foo, CC: ccfoo@hku.hk | - |
dc.identifier.email | Wei, R: rwei@hku.hk | - |
dc.identifier.email | Law, WL: lawwl@hkucc.hku.hk | - |
dc.identifier.authority | Foo, CC=rp01899 | - |
dc.identifier.authority | Law, WL=rp00436 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1007/s00268-017-4090-8 | - |
dc.identifier.pmid | 28620675 | - |
dc.identifier.scopus | eid_2-s2.0-85020513410 | - |
dc.identifier.hkuros | 274168 | - |
dc.identifier.volume | 41 | - |
dc.identifier.issue | 11 | - |
dc.identifier.spage | 2912 | - |
dc.identifier.epage | 2922 | - |
dc.identifier.isi | WOS:000413114900033 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 0364-2313 | - |