Document Detail


Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?
MedLine Citation:
PMID:  23298948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: For low-lying rectal cancers, proximal diversion can reduce anastomotic leak after sphincter-preserving surgery; however, evidence suggests that such temporary diversions are often not reversed. We aimed to evaluate nonreversal and delayed stoma reversal in elderly patients undergoing low anterior resection (LAR).
DESIGN: SEER-Medicare-linked analysis from 1991-2007.
SETTINGS AND PARTICIPANTS: A total of 1179 primary stage I-III rectal cancer patients over age 66 who underwent LAR with synchronous diverting stoma.
MAIN OUTCOME MEASURES: (1) Stoma creation and reversal rates; (2) time to reversal; (3) characteristics associated with reversal and shorter time to reversal.
RESULTS: Within 18 mo of LAR, 51% of patients (603/1179) underwent stoma reversal. Stoma reversal was associated with age <80 y (P < 0.0001), male sex (P = 0.018), fewer comorbidities (P = 0.017), higher income (quartile 4 versus 1; P = 0.002), early tumor stage (1 versus 3; P < 0.001), neoadjuvant radiation (P < 0.0001), rectal tumor location (versus rectosigmoid; P = 0.001), more recent diagnosis (P = 0.021), and shorter length of stay on LAR admission (P = 0.021). Median time to reversal was 126 d (interquartile range: 79-249). Longer time to reversal was associated with older age (P = 0.031), presence of comorbidities (P = 0.014), more advanced tumor stage (P = 0.007), positive lymph nodes (P = 0.009), receipt of adjuvant radiation therapy (P = 0.008), more recent diagnosis (P = 0.004), and longer length of stay on LAR admission (P < 0.0001).
CONCLUSIONS: Half of elderly rectal cancer patients who undergo LAR with temporary stoma have not undergone stoma reversal by 18 mo. Identifiable risk factors predict both nonreversal and longer time to reversal. These results help inform preoperative discussions and promote realistic expectations for elderly rectal cancer patients.
Authors:
Christopher M Dodgion; Bridget A Neville; Stuart R Lipsitz; Yue-Yung Hu; Deborah Schrag; Elizabeth Breen; Caprice C Greenberg
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-12-21
Journal Detail:
Title:  The Journal of surgical research     Volume:  183     ISSN:  1095-8673     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-17     Completed Date:  2013-08-27     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  238-45     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / surgery*
Aged
Female
Hospitals / statistics & numerical data
Humans
Male
Rectal Neoplasms / surgery*
Retrospective Studies
SEER Program
Surgical Stomas / statistics & numerical data*,  utilization
Grant Support
ID/Acronym/Agency:
T32 CA009535/CA/NCI NIH HHS; T32-CA009535-23/CA/NCI NIH HHS
Comments/Corrections

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