{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T19:55:36Z","timestamp":1785614136116,"version":"3.56.0"},"reference-count":36,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,6,15]],"date-time":"2017-06-15T00:00:00Z","timestamp":1497484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,6,15]],"date-time":"2017-06-15T00:00:00Z","timestamp":1497484800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Advances in surgical techniques and paradigm changes in rectal cancer treatment have led to a drastic decline in the abdominoperineal resection rate, and sphincter\u2010preserving operation is possible in distal rectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this study is to evaluate the long\u2010term incidence of permanent stoma after sphincter\u2010preserving surgery for low rectal cancer and its corresponding risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>From 2000 to 2014, patients who underwent sphincter\u2010preserving low anterior resection for low rectal cancer (within 5\u00a0cm from the anal verge) were included. The occurrence of permanent stoma over time and its risk factors were investigated by using a Cox proportional hazards regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 194 patients who underwent ultra\u2010low anterior resection for distal rectal cancer, and the median follow\u2010up period was 77\u00a0months for the surviving patients. Forty\u2010six (23.7%) patients required a permanent stoma eventfully. Anastomotic\u2010related complications and disease progression were the main reasons for permanent stoma. Clinical anastomotic leakage (HR 5.72; 95% CI 2.31\u201314.12; <jats:italic>p<\/jats:italic> &lt; 0.001) and neoadjuvant chemoradiation (HR 2.34; 95% CI 1.12\u20134.90; <jats:italic>p<\/jats:italic> = 0.024) were predictors for permanent primary stoma. Local recurrence (HR 16.09; 95% CI 5.88\u201344.03; <jats:italic>p<\/jats:italic> &lt; 0.001) and T4 disease (HR 11.28; 95% CI 2.99\u201342.49; <jats:italic>p<\/jats:italic> &lt; 0.001) were predictors for permanent secondary stoma. The 5\u2010 and 10\u2010year cumulative incidence for permanent stoma was 24.1 and 28.0%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Advanced disease, prior chemoradiation, anastomotic leakage and local recurrence predispose patients to permanent stoma should be taken into consideration when contemplating sphincter\u2010preserving surgery.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4090-8","type":"journal-article","created":{"date-parts":[[2017,6,15]],"date-time":"2017-06-15T21:19:43Z","timestamp":1497561583000},"page":"2912-2922","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Sphincter\u2010Preserving Surgery for Low Rectal Cancers: Incidence and Risk Factors for Permanent Stoma"],"prefix":"10.1002","volume":"41","author":[{"given":"Joanna Chung Kiu","family":"Mak","sequence":"first","affiliation":[{"name":"Department of Surgery, Queen Mary Hospital University of Hong Kong Pokfulam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic Chi Chung","family":"Foo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen Mary Hospital University of Hong Kong Pokfulam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rockson","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen Mary Hospital University of Hong Kong Pokfulam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Lun","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen Mary Hospital University of Hong Kong Pokfulam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,6,15]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2008.09.012"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02626778"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800691019"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000154551.06768.e1"},{"key":"e_1_2_8_6_2","first-page":"710","article-title":"An improved technique for low anterior resection of the rectum using the EEA stapler","volume":"88","author":"Knight CD","year":"1980","journal-title":"Surgery"},{"key":"e_1_2_8_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040694"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800830726"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/PL00012331"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133185.23514.32"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s003840050086"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02235256"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1463\u20101318.2003.t01\u20101\u201000503.x"},{"key":"e_1_2_8_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010013\u20102145\u2010z"},{"key":"e_1_2_8_15_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1463\u20101318.4.s1.1_78.x"},{"key":"e_1_2_8_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(07)70047\u20105"},{"key":"e_1_2_8_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2009.01815.x"},{"key":"e_1_2_8_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2010.02252.x"},{"key":"e_1_2_8_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181fd2948"},{"key":"e_1_2_8_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181ed0aae"},{"key":"e_1_2_8_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31829ef472"},{"key":"e_1_2_8_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010012\u20101038\u20101"},{"key":"e_1_2_8_23_2","first-page":"385","article-title":"Taylor EW Proposed definitions for the audit of postoperative infection: a discussion paper. 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