Risk factors for permanent stoma after low anterior resection

Introduction: Postoperative anastomotic leakage is a serious complication in rectal surgery that affects quality of life, increases morbidity and mortality rates, and worsens oncologic outcomes. One of the methods that can minimize septic complications is a diverting ostomy. Although intended as temporary, approximately 20% of diverting stomas become permanent or are converted to end colostomies. Factors significantly increasing the risk of permanent stomas include advanced age, local recurrence, stoma-related complications, and impaired anal sphincter function caused by denervation during surgery or due to neo-adjuvant or adjuvant radiotherapy. Aim: This study aimed to identify the risk factors that increase the possibility of temporary stoma becoming permanent after low anterior resection. Materials and methods: For the described period, we reviewed a total of 418 histologically confirmed rectal cancer patients who underwent low anterior resection with temporary diverting ileostomy. Results: Our study included 348 patients, of whom 324 (93.1%) had their stomas reversed. After a median follow-up of 50.4 months (range 6-106 months), 324 (93.1%) patients had temporary stomas and 24 (6.9%) had permanent ones. Of the 24 permanent stoma patients, there were 12 ileostomies (50.0%), 6 colostomies (25.0%), six patients with abdominoperineal resections (25.0%) due to total dehiscence of the anastomosis. Conclusion: Neo-adjuvant or adjuvant chemo and/or radiation therapy, local recurrence, and anastomotic leakage could be important risk factors for the stoma’s nonclosure or re-creation after primary closure in low rectal cancer patients. Surgeons should be more alert in the stoma closure of these risk patients.