Elderly rectal cancer patients at risk for stoma non-reversal

Half of elderly rectal cancer patients who undergo low anterior resection (LAR) do not have stoma reversal surgery within 18 months, show US data.

Elderly patients were also more likely than younger patients to experience delay in reversal when the surgery was performed.

"Given the decreased quality of life associated with diverting stoma and reported associated complication rates, preoperative discussions should include this information in order to set realistic expectations for patients and aid in informed, individualized decision making," say Caprice Greenberg (University of Wisconsin, Madison, USA) and colleagues.

The authors analyzed the Medicare data of 1179 patients with stage I-III rectal cancer aged over 66 years who had a diverting stoma created at the same time as LAR.

Within 18 months of surgery, only 51% of patients underwent stoma reversal. When the authors accounted for patients who died or could not be followed up, the reversal rate was still only 57%. This compares with a rate of 68-92% reported in previous studies of patients of all ages, Greenberg and colleagues say.

They found that patients aged under 80 years had a 2.3-fold greater odds for undergoing stoma reversal compared with older patients. The median age at diagnosis among patients who did not have their stoma reversed was significantly greater, at 77.8 years, compared with patients who did have a reversal, at 73.4 years. Additionally, being over 80 years old increased patients' risk for delayed stoma reversal.

Male gender, higher income, earlier tumor stage, receiving neoadjuvant radiation, rectal location of the tumor (as opposed to rectosigmoid), and shorter length of stay after LAR were all also significantly associated with increased odds for undergoing stoma reversal.

Interestingly, the authors also found that over time, hospitals became both more likely to perform stoma creation as well as stoma reversal.

While stoma creation has been shown to be protective, the authors explain that stoma closure can contribute to morbidity and mortality, which may be an important consideration in elderly patients.

The authors, writing in the Journal of Surgical Research, say theirs is one of only a few studies to perform multivariate analysis of the factors influencing stoma closure. The findings, they conclude, should help to inform discussions and decision-making with elderly rectal cancer patients in the future.

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