1 Department of Surgery, Paracelsus Medical University, Salzburg, Austria 2 Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria.
Dis Colon Rectum. 2013 Oct;56(10):1134-42. doi: 10.1097/DCR.0b013e31829ef472.
Changes in the treatment of rectal cancer during the past decades have led to an increase in sphincter preservation with a consecutive decline in abdominoperineal resection rates.
The aim of this study was to analyze the cumulative incidence of permanent stoma in patients undergoing sphincter-preserving resection of mid and low rectal cancer.
This study is a retrospective analysis of prospectively collected data.
This study was conducted at a tertiary referral cancer hospital.
From 2003 to 2010, 125 patients with primary mid and low rectal cancer who underwent sphincter-preserving low anterior resection were included.
The occurrence of a permanent stoma over time was investigated by using a Cox proportional hazards regression model and competing-risk models, with death as a competing risk. The risk factors were assessed by computing HRs and a Cox proportional hazards regression.
After a median follow-up time of 61 months (range, 22-113), 15 of 125 patients ended up with a permanent stoma, accounting for a 5-year cumulative incidence of 6% (95% CI, 4%-11%). The reasons for obtaining a permanent stoma were anastomotic leakage (60%, 9/15), intractable fecal incontinence (27%, 4/15), and local recurrence (13%, 2/15). The Cox proportional hazards regression identified anastomotic leakage (HR, 6.10; 95% CI, 2.23-16.71; p = 0.0004) and coloanal anastomosis (HR, 4.31; 95% CI, 1.49-12.47; p = 0.007) as statistically significant risk factors.
Because of the small number of events in this sample, further investigations with a larger number of patients are required. Fecal incontinence was assessed by patient self-reported data without the use of a validated score.
The 5-year cumulative incidence of a permanent stoma was 6%. Anastomotic leakage and coloanal anastomosis were identified as risk factors. These details should be considered before sphincter-preserving surgery.
在过去几十年中，直肠癌治疗方法的改变导致了保肛手术的增加，而腹会阴联合切除术的比例相应下降。
本研究旨在分析中低位直肠癌保肛手术后永久性造口的累积发生率。
这是一项回顾性分析前瞻性收集数据的研究。
本研究在一家三级转诊癌症医院进行。
2003 年至 2010 年，共纳入 125 例接受保肛低位前切除术的原发性中低位直肠癌患者。
采用 Cox 比例风险回归模型和竞争风险模型分析时间推移过程中永久性造口的发生情况，以死亡为竞争风险。通过计算 HR 和 Cox 比例风险回归来评估风险因素。
中位随访时间 61 个月（范围，22-113 个月）后，125 例患者中有 15 例出现永久性造口，5 年累积发生率为 6%（95%CI，4%-11%）。获得永久性造口的原因包括吻合口漏（60%，9/15）、难以控制的粪便失禁（27%，4/15）和局部复发（13%，2/15）。Cox 比例风险回归分析显示，吻合口漏（HR，6.10；95%CI，2.23-16.71；p=0.0004）和结肠肛管吻合术（HR，4.31；95%CI，1.49-12.47；p=0.007）是统计学上的显著风险因素。
由于该样本中事件数量较少，需要进一步进行更多患者的研究。粪便失禁通过患者自我报告的数据进行评估，而没有使用经过验证的评分。
永久性造口的 5 年累积发生率为 6%。吻合口漏和结肠肛管吻合术被确定为风险因素。在进行保肛手术前应考虑这些细节。
