Determinants of stoma reversal in rectal cancer patients who had an anterior resection between 2009 and 2012 in the English National Health Service

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Abstract

Aim

The rate of ileostomy reversal was estimated in patients undergoing an elective anterior resection for rectal cancer and factors associated with reversal were identified.

Method

The records of 4879 rectal patients who had an ileostomy created during anterior resection between 2009 and 2012 were identified in the National Bowel Cancer Audit database and linked to administrative records of the Hospital Episode Statistics. Patients were followed from surgery. Multivariable proportional hazards regression was used to estimate the impact of patient and cancer characteristics on ileostomy reversal with death as the competing risk.

Results

Within 18 months from anterior resection, 3536 (72.5%) patients had undergone ileostomy reversal. The reversal rate was lower in the following circumstances: older patients [hazard ratio (HR) 0.90; 95% CI 0.84–0.96, aged 80 vs 70 years], male gender (HR 0.90; 0.84–0.97), higher American Society of Anesthesiologists (ASA) grade (HR 0.64; 0.56–0.74, ASA 3+ vs 1), more advanced cancer (HR 0.77; 0.69–0.87, T3 vs T1), socioeconomic deprivation (HR 0.83; 0.74–0.93, most vs least deprived quintile), comorbidity (HR 0.92; 0.84–1.00, one vs no comorbidity) and open surgical procedure (HR 0.90; 0.84–0.97, open vs laparoscopic).

Conclusion

Overall, two-thirds of ileostomies were reversed within 18 months. Reversal rates were linked to patient and cancer characteristics (age, sex, fitness and stage), mode of surgical access and socioeconomic deprivation. Observed lower reversal rates in patients from poorer backgrounds may indicate inequity in access.

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