Risk Factors For Conversion From Temporary Stoma To Permanent Stoma In Rectal Cancer Patients

Objective: This study retrospectively analyzed the clinical data of patients with rectal cancer undergoing sphincter-preserving surgery in the First Affiliated Hospital of Guangxi Medical University,and investigate the incidence of permanent stoma after sphincter-preserving surgery for rectal cancer and permanent stoma related risk factors.Research objects and methods: This study retrospectively analyzed the clinical data of 169 patients with rectal cancer who underwent sphincter-preserving surgery and ileostomy in the Department of colorectal and anal surgery of the First Affiliated Hospital of Guangxi Medical University during June 2013 to December 2018..Gender,age,BMI,CEA,hemoglobin,albumin,diabetes mellitus,distance from tumor to anal margin,neoadjuvant chemoradiotherapy,anastomotic leakage,anastomotic stenosis,tumor histological grade,T stage,N stage,local recurrence and distant metastasis were analyzed,Multivariate logistic regression analysis was used to screen out the risk factors of permanent stoma after sphincter-preserving surgery for rectal cancer.Results: In the colorectal and anal surgery department of the First Affiliated Hospital of Guangxi Medical University during June 2013 to December 2018,169 patients were included to this study,and 18(10.7%)patients needed permanent stoma.Univariate analysis results:neoadjuvant chemoradiotherapy(P = 0.019),anastomotic leakage(P =0.014),T stage(P = 0.049),N stage(P = 0.002),local recurrence(P =0.000),distant metastasis(P = 0.000),a nastomotic stenosis(P = 0.000)were statistically significant in permanent stoma group and non permanent stoma group.There were no statistical significance in gender(P = 0.869),BMI(P = 0.298),diabetes mellitus(P = 0.862),tumo r distance from anal ma rgin(P = 0.979),tumor histological grade(P =0.244),age(P = 0.333),preoperative CEA(P = 0.050),albumin(P =0.345)and hemoglobin(P = 0.737)between the two groups.Multivariate logistic regression analysis showed that neoadjuvant chemoradiotherapy(OR = 9.105,95% CI: 1.489-55.684),anastomotic leakage(OR = 14.681,95% CI: 1.956-110.175),distant metastasis(OR= 77.581,95% CI: 9.505-633.232)and anastomotic stenosis(OR =63.580,95% CI: 8.786-460.109)were independent risk factors for permanent stoma.The anastomotic leakage,anastomotic stenosis and rectovaginal fistula were classified as anastomotic related complications.Univariate analysis results: gender(P = 0.018)and preoperative CEA(P = 0.003)were statistically significant between the two groups,BMI(P = 0.298),diabetes(P = 0.330),distance between tumor and anal margin(P =0.527),neoadjuvant chemoradiotherapy(P = 0.461),tumor nature(P =0.993)There were no significant difference in T stage(P = 0.080),N stage(P = 0.068),age(P = 1.000),albumin(P = 0.716),hemoglobin(P= 0.673)between the two groups.Conclusion:Neoadjuvant chemoradiotherapy,anastomotic leakage,anastomotic stenosis,local recurrence and distant metastasis are important factors for permanent stoma in patients with rectal cancer undergoing sphincter-preserving surgery.In addition,male is a risk factor for anastomotic complications in this study.