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Article: Sphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma

TitleSphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma
Authors
Issue Date2017
PublisherSpringer 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?
AbstractBackground: 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 Identifierhttp://hdl.handle.net/10722/243827
ISSN
2019 Impact Factor: 2.234
2015 SCImago Journal Rankings: 1.375
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorMak, JCK-
dc.contributor.authorFoo, CC-
dc.contributor.authorWei, R-
dc.contributor.authorLaw, WL-
dc.date.accessioned2017-08-25T03:00:01Z-
dc.date.available2017-08-25T03:00:01Z-
dc.date.issued2017-
dc.identifier.citationWorld Journal of Surgery, 2017, v. 41 n. 11, p. 2912-2922-
dc.identifier.issn0364-2313-
dc.identifier.urihttp://hdl.handle.net/10722/243827-
dc.description.abstractBackground: 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.languageeng-
dc.publisherSpringer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/-
dc.relation.ispartofWorld Journal of Surgery-
dc.rightsThe final publication is available at Springer via http://dx.doi.org/[insert DOI]-
dc.titleSphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma-
dc.typeArticle-
dc.identifier.emailFoo, CC: ccfoo@hku.hk-
dc.identifier.emailWei, R: rwei@hku.hk-
dc.identifier.emailLaw, WL: lawwl@hkucc.hku.hk-
dc.identifier.authorityFoo, CC=rp01899-
dc.identifier.authorityLaw, WL=rp00436-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00268-017-4090-8-
dc.identifier.pmid28620675-
dc.identifier.scopuseid_2-s2.0-85020513410-
dc.identifier.hkuros274168-
dc.identifier.volume41-
dc.identifier.issue11-
dc.identifier.spage2912-
dc.identifier.epage2922-
dc.identifier.isiWOS:000413114900033-
dc.publisher.placeUnited States-

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