Faculty Collaboration Database

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer? J Surg Res 2013 Jul;183(1):238-45

Date

01/10/2013

Pubmed ID

23298948

Pubmed Central ID

PMC3686838

DOI

10.1016/j.jss.2012.11.057

Scopus ID

2-s2.0-84879106581 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

OBJECTIVE: For low-lying rectal cancers, proximal diversion can reduce anastomotic leak after sphincter-preserving surgery; however, evidence suggests that such temporary diversions are often not reversed. We aimed to evaluate nonreversal and delayed stoma reversal in elderly patients undergoing low anterior resection (LAR).

DESIGN: SEER-Medicare-linked analysis from 1991-2007.

SETTINGS AND PARTICIPANTS: A total of 1179 primary stage I-III rectal cancer patients over age 66 who underwent LAR with synchronous diverting stoma.

MAIN OUTCOME MEASURES: (1) Stoma creation and reversal rates; (2) time to reversal; (3) characteristics associated with reversal and shorter time to reversal.

RESULTS: Within 18 mo of LAR, 51% of patients (603/1179) underwent stoma reversal. Stoma reversal was associated with age <80 y (P < 0.0001), male sex (P = 0.018), fewer comorbidities (P = 0.017), higher income (quartile 4 versus 1; P = 0.002), early tumor stage (1 versus 3; P < 0.001), neoadjuvant radiation (P < 0.0001), rectal tumor location (versus rectosigmoid; P = 0.001), more recent diagnosis (P = 0.021), and shorter length of stay on LAR admission (P = 0.021). Median time to reversal was 126 d (interquartile range: 79-249). Longer time to reversal was associated with older age (P = 0.031), presence of comorbidities (P = 0.014), more advanced tumor stage (P = 0.007), positive lymph nodes (P = 0.009), receipt of adjuvant radiation therapy (P = 0.008), more recent diagnosis (P = 0.004), and longer length of stay on LAR admission (P < 0.0001).

CONCLUSIONS: Half of elderly rectal cancer patients who undergo LAR with temporary stoma have not undergone stoma reversal by 18 mo. Identifiable risk factors predict both nonreversal and longer time to reversal. These results help inform preoperative discussions and promote realistic expectations for elderly rectal cancer patients.

Author List

Dodgion CM, Neville BA, Lipsitz SR, Hu YY, Schrag D, Breen E, Greenberg CC

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Aged
Female
Hospitals
Humans
Male
Rectal Neoplasms
Retrospective Studies
SEER Program
Surgical Stomas