Risk factor for permanent stoma and incontinence quality of life after sphincter-preserving surgery for low rectal cancer without a diverting stoma.

Abstract

The goal of the present study was to evaluate permanent stoma formation and defecation function in long‐term follow up after surgery for low rectal cancer without a diverting stoma. Subjects were 275 patients who underwent sphincter‐preserving surgery for low rectal cancer between 2000 and 2012. Clinical outcomes were evaluated and defecation function was assessed based on a questionnaire survey, using Wexner and modified fecal incontinence quality of life (mFIQL) scores. Incidence of anastomotic leakage was 21.8%, and surgery‐related death as a result of anastomotic leakage occurred in one male patient. Median follow‐up period was 4.9 years and permanent stoma formation rate was 16.7%. Anastomotic leakage was an independent predictor of permanent stoma formation (odds ratio [OR] 5.86, P<0.001). Age <65 years (OR 1.99, P=0.001) and male gender (OR 4.36, P=0.026) were independent predictors of anastomotic leakage. A permanent stoma was formed as a result of poor healing of anastomotic leakage in 29.6% of males, but in no females. Defecation function was surveyed in 27 and 116 patients with and without anastomotic leakage, respectively. These groups had no significant differences in median follow‐up period (63.5 vs 63 months), Wexner scores (quartile) (6 (2.5‐9) vs 6 (3‐11)), and mFIQL scores (26.1 (4.8‐64.2) vs 23.8 (5.9‐60.7). Defecation function associated with anastomotic leakage showed no significant dependence on gender or resection procedure. Sphincter‐preserving surgery without a diverting stoma may be indicated for females with low rectal cancer. In this procedure, male gender is a risk factor for anastomotic leakage and subsequent formation of a permanent stoma in one in three patients.