1. Predictors for temporary stomas non-closure among non-metastatic rectal cancer patients undergoing curative resection: a retrospective analysis.
- Author
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Hsu CC, Tsai WS, Tsai TY, You JF, Yeh CY, Hsieh PS, Tang R, and Huang SH
- Subjects
- Humans, Retrospective Studies, Female, Male, Middle Aged, Aged, Prognosis, Risk Factors, Follow-Up Studies, Anastomotic Leak etiology, Anastomotic Leak epidemiology, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local surgery, Postoperative Complications etiology, Postoperative Complications epidemiology, Adult, Proctectomy methods, Proctectomy adverse effects, Aged, 80 and over, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Surgical Stomas adverse effects
- Abstract
Background: The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop a predictive model for stoma non-closure in rectal cancer patients who underwent curative-intent low anterior resection., Methods: Consecutive patients diagnosed with non-metastatic rectal cancer between January 2005 and December 2017, who underwent low anterior resection, were retrospectively included in the Chang Gung Memorial Foundation Institutional Review Board. A comprehensive evaluation and analysis of potential risk factors linked to stoma non-closure were performed., Results: Out of 956 patients with temporary stomas, 10.3% (n = 103) experienced non-closure primarily due to cancer recurrence and anastomosis-related issues. Through multivariate analysis, several preoperative risk factors significantly associated with stoma non-closure were identified, including advanced age, anastomotic leakage, positive nodal status, high preoperative CEA levels, lower rectal cancer presence, margin involvement, and an eGFR below 30 mL/min/1.73m2. A risk assessment model achieved an AUC of 0.724, with a cutoff of 2.5, 84.5% sensitivity, and 51.4% specificity. Importantly, the non-closure rate could rise to 16.6% when more than two risk factors were present, starkly contrasting the 3.7% non-closure rate observed in cases with a risk score of 2 or below (p < 0.001)., Conclusion: Prognostic risk factors associated with the non-closure of a temporary stoma include advanced age, symptomatic anastomotic leakage, nodal status, high CEA levels, margin involvement, and an eGFR below 30 mL/min/1.73m2. Hence, it is crucial for surgeons to evaluate these factors and provide patients with a comprehensive prognosis before undergoing surgical intervention., (© 2024. The Author(s).)
- Published
- 2024
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