Annals of Coloproctology

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Colorectal cancer

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study: Ahmad Sakr, Seung Yoon Yang, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2024;40(1):27-35. Published online February 28, 2024; DOI: https://doi.org/10.3393/ac.2022.01067.0152

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Purpose
Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer.
Methods
In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included.
Results
Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction.
Conclusion
Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

Citations

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Funktionelle Folgen von Radiotherapie, Chemotherapie und Operation bei der Behandlung des Rektumkarzinoms
Philipp Rhode, Matthias Mehdorn, Undine Gabriele Lange, Sebastian Murad Rabe, Johannes Quart, Robert Nowotny, Patrick Sven Plum, Stefan Niebisch, Sigmar Stelzner
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2025; 150(04): 353. CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Multivariate Analysis of Risk Factors Associated With the Nonreversal Ileostomy Following Sphincter-Preserving Surgery for Rectal Cancer: Young Ah Kim, Gil Jae Lee, Sung Won Park, Won-Suk Lee, Jeong-Heum Baek; Ann Coloproctol. 2015;31(3):98-102. Published online June 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.3.98

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35 Download
20 Web of Science
21 Citations

Abstract PDF

Purpose

A loop ileostomy is used to protect an anastomosis after anal sphincter-preserving surgery, especially in patients with low rectal cancer, but little information is available concerning risk factors associated with a nonreversal ileostomy. The purpose of this study was to identify risk factors of ileostomy nonreversibility after a sphincter-saving resection for rectal cancer.

Methods

Six hundred seventy-nine (679) patients with rectal cancer who underwent sphincter-preserving surgery between January 2004 and December 2011 were evaluated retrospectively. Of the 679, 135 (19.9%) underwent a defunctioning loop ileostomy of temporary intent, and these patients were divided into two groups, that is, a reversal group (RG, 112 patients) and a nonreversal group (NRG, 23 patients) according to the reversibility of the ileostomy.

Results

In 23 of the 135 rectal cancer patients (17.0%) that underwent a diverting ileostomy, stoma reversal was not possible for the following reasons; stage IV rectal cancer (11, 47.8%), poor tone of the anal sphincter (4, 17.4%), local recurrence (2, 8.7%), anastomotic leakage (1, 4.3%), radiation proctitis (1, 4.3%), and patient refusal (4, 17.4%). The independent risk factors of the nonreversal group were anastomotic leakage or fistula, stage IV cancer, local recurrence, and comorbidity.

Conclusion

Postoperative complications such as anastomotic leakage or fistula, advanced primary disease (stage IV), local recurrence and comorbidity were identified as risk factors of a nonreversal ileostomy. These factors should be considered when drafting prudential guidelines for ileostomy closure.

Citations

Citations to this article as recorded by

Early vs. Late Stoma Reversal After Open Low Anterior Resection Post-Neoadjuvant Chemoradiotherapy
Fahad Bin Abdul Majeed, Madhu Muralee, Chandramohan
Indian Journal of Surgical Oncology.2025; 16(1): 94. CrossRef
Preoperative risk factors and cumulative incidence of temporary ileostomy non-closure after sphincter-preserving surgery for rectal cancer: a meta-analysis
Fan He, Chenglin Tang, Fuyu Yang, Defei Chen, Junjie Xiong, Yu Zou, Dongqin Zhao, Kun Qian
World Journal of Surgical Oncology.2024;[Epub] CrossRef
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Elisabeth Hain, Jérémie H. Lefèvre, Alison Ricardo, Sang Lee, Karen Zaghiyan, Elisabeth McLemore, Danny Sherwinter, Rebecca Rhee, Matthew Wilson, Joseph Martz, Justin Maykel, John Marks, Jorge Marcet, Philippe Rouanet, Leon Maggiori, Niels Komen, Nicolas
Colorectal Disease.2024; 26(6): 1271. CrossRef
The Determinants of Long-Term Outcomes After Colorectal Cancer Surgery: A Literature Review
Olorungbami K Anifalaje, Charles Ojo, Oluwaseyi T Balogun, Fikayo A Ayodele, Abeeb Azeez, Shirley Gabriels
Cureus.2024;[Epub] CrossRef
Determination of Factors Related to the Reversal and Perioperative Outcomes of Defunctioning Ileostomies in Patients Undergoing Rectal Cancer Surgery: A Regression Analysis Model
Ioannis Baloyiannis, Konstantinos Perivoliotis, Ioannis Mamaloudis, Effrosyni Bompou, Chamaidi Sarakatsianou, George Tzovaras
Journal of Gastrointestinal Cancer.2023; 54(3): 782. CrossRef
Effect of 3D Animation Combined with Teach-Back Health Education on Pelvic Floor Muscle Training in LARS Patients: A Randomized Controlled Trial
Jingjing Ye, Xiaoyan Xu, Shengnian Lu, Xiaojun Xu, Hanmei Liu, Mingxian Luo, Jiamei Zhou, Lianhong Wang, Yongmei Zhang, Nabeel Al-Yateem
Journal of Nursing Management.2023; 2023: 1. CrossRef
Risk factors and incidence of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma: A systematic review and meta-analysis
Lu Zhou, Zuming Qin, Ling Wang
European Journal of Surgical Oncology.2023; 49(12): 107120. CrossRef
Temporary Stomas after Rectal Cancer Resection; Predilection of Being Permanent and Predictors of Complications?
Islam H. Metwally, Mohamed Abdelkhalek, Mohammad Zuhdy, Saleh S. Elbalka
Journal of Coloproctology.2023; 43(03): e191. CrossRef
The safety of early versus late ileostomy reversal after low anterior rectal resection: a retrospective study in 47 patients
Ian Fukudome, Hiromichi Maeda, Ken Okamoto, Hajime Kuroiwa, Sachi Yamaguchi, Kazune Fujisawa, Mai Shiga, Ken Dabanaka, Michiya Kobayashi, Tsutomu Namikawa, Kazuhiro Hanazaki
Patient Safety in Surgery.2021;[Epub] CrossRef
Risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer: univariate and multivariate analysis
M.V. Alekseev, Yu.A. Shelygin, E.G. Rybakov
Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (2): 40. CrossRef
Morbidity and costs of diverting ileostomy in transanal total mesorectal excision with primary anastomosis for rectal cancer
J. C. Hol, F. Bakker, N. T. van Heek, G. M. de Jong, F. M. Kruyt, C. Sietses
Techniques in Coloproctology.2021; 25(10): 1133. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
European Journal of Oncology Nursing.2021; 55: 102059. CrossRef
Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function
S. Kim, M. H. Kim, J. H. Oh, S.‐Y. Jeong, K. J. Park, H.‐K. Oh, D.‐W. Kim, S.‐B. Kang
Colorectal Disease.2020; 22(4): 399. CrossRef
The fate of preserved sphincter in rectal cancer patients
Ri Na Yoo, Gun Kim, Bong-Hyeon Kye, Hyeon-Min Cho, HyungJin Kim
International Journal of Colorectal Disease.2018; 33(6): 745. CrossRef
Patients With Temporary Ostomies
Mohammed Iyoob Mohammed Ilyas, David A. Haggstrom, Melinda A. Maggard-Gibbons, Christopher S. Wendel, Susan Rawl, Christian Max Schmidt, Clifford Y. Ko, Robert S. Krouse
Journal of Wound, Ostomy & Continence Nursing.2018; 45(6): 510. CrossRef
Risk Factors Associated With Nonclosure of Defunctioning Stomas After Sphincter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis
Xin Zhou, Bingyan Wang, Fei Li, Jilian Wang, Wei Fu
Diseases of the Colon & Rectum.2017; 60(5): 544. CrossRef
Use of a nomogram to predict the closure rate of diverting ileostomy after low anterior resection: A retrospective cohort study
Shinya Abe, Kazushige Kawai, Hiroaki Nozawa, Keisuke Hata, Tomomichi Kiyomatsu, Toshiaki Tanaka, Takeshi Nishikawa, Kensuke Otani, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Shigenobu Emoto, Toshiaki Watanabe
International Journal of Surgery.2017; 47: 83. CrossRef
Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer
Mustafa Haksal, Nuri Okkabaz, Ali Emre Atici, Osman Civil, Yasar Ozdenkaya, Ayhan Erdemir, Nihat Aksakal, Mustafa Oncel
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World Journal of Surgical Oncology.2017;[Epub] CrossRef
Stoma Creation After Surgery for Rectal Cancer: Temporary or Permanent?
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Annals of Coloproctology.2015; 31(3): 82. CrossRef

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