Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery

Table 1 Comparison of patient-related characteristics between the stoma free and permanent stoma groups

Characteristic	Stoma free (n = 332)	Permanent stoma (n = 89)	P value
Age, yr	60.78 ± 12.80	60.56 ± 12.60	0.888
Sex (n)			0.716
Male	196 (59.04%)	50 (56.18%)
Female	136 (40.96%)	39 (43.82%)
Body mass index, kg/m2	24.00 ± 3.97	24.47 ± 4.32	0.331
Comorbidity (n)
DM	68 (20.48%)	14 (15.73%)	0.393
Hypertension	103 (31.02%)	33 (7.08%)	0.339
Heart disease	25 (7.53%)	8 (8.99%)	0.816
COPD	2 (0.60%)	2 (2.25%)	0.421
Chronic kidney disease	36 (10.84%)	9 (10.11%)	0.996
Liver disease	39 (11.75%)	10 (11.24%)	1
Smoker (n)	49 (14.76%)	9 (10.11%)	0.339
Distance to anus verge, cm	7.06 ± 3.52	4.68 ± 3.96	< 0.001
Clinical T stage (n)			0.002
T0	8 (2.41%)	1 (1.13%)
T1	12 (3.61%)	1 (1.13%)
T2	50 (15.06%)	8 (8.98%)
T3	218 (65.66%)	56 (62.92%)
T4	20 (6.03%)	17 (19.10%)
Data loss	24 (7.23%)	6 (6.74%)
Clinical N stage (n)			0.44
N0	108 (32.53%)	23 (25.84%)
N1	100 (30.12%)	31 (34.83%)
N2	100 (30.12%)	29 (32.59%)
Data loss	24 (7.23%)	6 (6.74%)
AJCC c TNM stage (n)			0.002
Stage 0	8 (2.41%)	1 (1.13%)
Stage I	49 (14.76%)	7 (7.86%)
Stage II	52 (15.66%)	15 (16.85%)
Stage III	199 (59.94%)	60 (67.42%)
Data loss	24 (7.23%)	6 (6.74%)
NACR (n)	222 (66.87%)	69 (77.53%)	0.026
Hb, g/dL	12.78 ± 1.57	12.52 ± 1.72	0.169
Albumin, g/dL	4.14 ± 0.36	4.08 ± 0.37	0.19
CEA, ng/mL	4.81 ± 8.58	6.15 ± 8.69	0.198
ASA score (n)			0.182
I	26 (7.83%)	3 (3.37%)
II	271 (81.63%)	73 (82.02%)
III	30 (9.03%)	12 (13.48%)
Data loss	5 (1.51%)	1 (1.13%)

ASA: American Society of Anesthesiologists; COPD: Chronic obstructive pulmonary disease; CEA: Carcinoembryonic antigen; DM: Diabetes mellitus; AJCC: American Joint Committee on Cancer; Hb: Hemoglobin; NCRT: Neoadjuvant chemoradiotherapy; TNM: Tumor-node-metastasis; NACR: Neoadjuvant chemoradiation.

Table 2 Risk factors for permanent stoma after sphincter-preserving surgery according to univariate and multivariable analyses

Variable	Univariable analysis OR (95%CI)	P value	Multivariable analysis OR (95%CI)	P value
Age, yr	0.99 (0.969-1.012)	0.369	0.959 (0.895-1.027)	0.232
Sex (Ref. = female)
Male	0.822 (0.472-1.443)	0.491	0.273 (1.044-1.7)	0.164
Body mass index, kg/m2	1.022 (0.953-1.092)	0.532	0.949 (0.807-1.116)	0.525
DM (Ref. = No)
Yes	0.792 (0.363-1.586)	0.532	0.307 (0.032-2.9)	0.303
Hypertension (Ref. = No)
Yes	1.229 (0.678-2.179)	0.488	0.819 (0.121-5.542)	0.838
Heart disease (Ref. = No)
Yes	0.893 (0.256-2.413)	0.84	0.229 (0.008-6.382)	0.385
COPD (Ref. = No)
Yes	5.795 (0.684-49.02)	0.082	451.125 (0.376->999)	0.091
CKD (Ref. = No)
Yes	0.931 (0.34-2.172)	0.878	0.421 (0.019-9.234)	0.583
Liver disease (Ref. = No)
Yes	1.179 (0.488-2.55)	0.694	0.054 (0.004-0.698)	0.025
Smoker (Ref. = No)
Yes	0.906 (0.379-1.932)	0.81	0.125 (0.007-2.148)	0.152
Distance to anus verge, cm	0.838 (0.758-0.921)	< 0.001	0.834 (0.618-1.127)	0.238
Clinical T stage (Ref. = T0)
T1	< 0.001 (NA-4.239)	0.98	1.081 (< 0.001-> 999)	0.999
T2	1.28 (0.193-25.357)	0.827	> 999 (< 0.001-> 999)	0.968
T3	1.394 (0.246-26.24)	0.757	> 999 (< 0.001-> 999)	0.976
T4	3.2 (0.468-64.31)	0.308	> 999 (< 0.001-> 999)	0.971
Clinical N stage (Ref. = N0)
N1	1.697 (0.831-3.568)	0.152	0.017 (< 0.001-> 999)	0.986
N2	1.466 (0.701-3.129)	0.313	0.003 (< 0.001-> 999)	0.981
AJCC c TNM stage (Ref. = Stage 0)
Stage I	0.98 (0.139-19.76)	0.986	0.015 (< 0.001-> 999)	0.986
Stage II	1.077 (0.159-21.492)	0.948	0.007 (< 0.001-> 999)	0.983
Stage III	1.648 (0.291-30.993)	0.642	NA	NA
Pre-operative CCRT (Ref. = No)
Yes	1.332 (0.731-2.533)	0.364	1.873 (0.137-25.575)	0.638
Hb, g/dL	0.987 (0.832-1.18)	0.887	1.404 (0.768-2.568)	0.27
Albumin, g/dL	0.821 (0.361-1.928)	0.643	0.66 (0.041-10.497)	0.769
CEA, ng/mL	1.011 (0.978-1.038)	0.443	0.936 (0.804-1.09)	0.396
ASA score (Ref. = I)
II	2.02 (1.046-3.891)	0.036	7.967 (0.64-99.127)	0.107
III	NA	NA	NA	NA
Surgical Approach way (Ref. = 0)
LPS (1)	NA	NA	> 999 (< 0.001-> 999)	0.859
Robotic (2)	NA	NA	> 999 (< 0.001-> 999)	0.872
Type of operation (Ref. = LAR)
CAA	3.46 (1.958-6.266)	< 0.001	0.221 (0.027-1.796)	0.158
Estimated blood loss	1.002 (1-1.005)	0.072	1.001 (0.987-1.016)	0.889
Operative time	1.004 (1.002-1.007)	< 0.001	1.011 (1.001-1.02)	0.026
Histologic tumor grade (Ref. = Grade I)
Grade II	1.622 (0.883-3.05)	0.124	1.203 (0.22-6.586)	0.831
Grade III	2.507 (0.645-8.203)	0.147	1.53 (0.038-61.785)	0.822
Tumor size, mm	1.026 (1.011-1.041)	< 0.001	1.076 (1.015-1.14)	0.014
Circumferential resection margin (Ref. = No)
Yes	6.575 (2.955-14.604)	< 0.001	0.936 (0.064-13.699)	0.961
Lymph vascular invasion (Ref. = No)
Yes	1.99 (1.071-3.617)	0.026	0.94 (0.132-6.715)	0.951
Perineural invasion (Ref. = No)
Yes	3.085 (1.726-5.518)	< 0.001	7.674 (1.138-51.745)	0.036
Postoperative hospital stays	1.05 (1.02-1.083)	0.001	1.003 (0.911-1.104)	0.953
Postoperative chemotherapy (Ref. = No)
Yes	1.907 (0.963-4.134)	0.079	4.281 (0.247-74.107)	0.318
Anastomosis site stenosis (Ref. = No)
Yes	11.648 (5.499-25.374)	< 0.001	211.256 (13.705-> 999)	< 0.001
Local recurrence (Ref. = No)
Yes	12.584 (5.874-27.885)	< 0.001	111.578 (7.964-> 999)	< 0.001
Postoperative leakage (Ref. = No)
Yes	2.659 (0.982-6.557)	0.041	0.743 (0.047-11.833)	0.833
Perirectal abscess (Ref. = No)
Yes	11.037 (3.22-43.367)	< 0.001	369.397 (17.137-> 999)	< 0.001
Recto visceral fistula (Ref. = No)
Yes	44.557 (7.71-841.643)	< 0.001	> 999 (< 0.001-> 999)	0.963

ASA: American Society of Anesthesiologists; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; AJCC: American Joint Committee on Cancer; CCRT: Concurrent chemoradiotherapy; CEA: Carcinoembryonic antigen; CAA: Coloanal anastomosis; DM: Ciabetes mellitus; Hb: Hemoglobin; LPS: Laparoscopic surgery; LAR: Low anterior resection; OR: Odd ratio; TNM: Tumor-node-metastasis.