Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.765
Peer-review started: March 4, 2022
First decision: June 12, 2022
Revised: June 21, 2022
Accepted: July 20, 2022
Article in press: July 20, 2022
Published online: August 27, 2022
Processing time: 173 Days and 4.4 Hours
Despite innovative advancements, the management of rectal cancer remains a formidable endeavor, especially distally located rectal cancer. According to previous studies, 3%-24% of rectal cancer patients experience anastomosis complications after sphincter-saving surgery, which may lead to permanent stoma (PS).
Patients fail to achieve stoma closure can cause drastic changes in lifestyle and physical perceptions.
The purpose of this study was to determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.
A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.
The PS stoma rate after sphincter-saving surgery was 15.1% (59/391) in our study after a median follow-up of 47.3 mo (range 7-114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size, liver disease, and operative time were independent risk factors for PS. After exclude liver disease, these identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903 (95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.
This study reports that risk factors leading to PS were highly correlated with local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time (min). Our established nomogram enables a relatively accurate assessment of the risk of PS after sphincter-saving surgery. The ease of use of this nomogram can improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.
The present study has some limitations. First, this was a retrospective study and was not randomized in nature. In some incomplete patient records, the details of stoma complications after hospital discharge may be difficult to evaluate. Second, the study period was relatively long, and differences may exist in surgeon discretion and surgical techniques. Finally, this analysis was based on data from a single center. External validation using data from other centers is needed to certify the discriminatory ability of this model. More representative prediction models can be developed using data from multiple centers.