{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:17:51Z","timestamp":1790983071993,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,6,24]],"date-time":"2013-06-24T00:00:00Z","timestamp":1372032000000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2013,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The morbidity of anastomotic dehiscence may be mitigated by a defunctioning stoma, but it is unclear if it is required for most low rectal anastomoses. Preoperative risk factors leading to anastomotic complications and the indications for faecal diversion have yet to be clearly defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Using the American College of Surgeons\u2010National Surgical Quality Improvement Project (<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">NSQIP<\/jats:styled-content>) participant\u2010use file, patients were identified who underwent low anterior resection with anastomosis for cancer at the 211 participating hospitals in 2005\u201308.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1791 patients underwent low anterior resection. Patients were subdivided into two groups based on the level of the anastomosis. Of these 1266 patients had a low pelvic anastomosis (<jats:styled-content style=\"fixed-case\">LPA<\/jats:styled-content>) and 525 a coloanal anastomosis (<jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content>). In the <jats:styled-content style=\"fixed-case\">LPA<\/jats:styled-content> group, 606 patients had a stoma and 660 had no stoma. There were no differences in wound complications, sepsis or septic shock. Patients who had a stoma were more likely to have postoperative acute renal failure (1.7 <jats:italic>vs<\/jats:italic> 0.5%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.0485, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 3.674). In the <jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content> group, 352 had a stoma and 173 had no stoma. In patients without faecal diversion, there was a significantly greater incidence of sepsis (8.7 <jats:italic>vs<\/jats:italic> 3.7%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.022, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.47), septic shock (3.5 <jats:italic>vs<\/jats:italic> 0.57%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.018, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 6.29) and need for reoperation (11 <jats:italic>vs<\/jats:italic> 1.7%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.0001, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 7.11). Hospital length of stay was significantly longer with <jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content> and no stoma. On multivariate analysis, not having a stoma with a <jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content> was a risk factor for serious postoperative morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While a defunctioning stoma with a coloanal anastomosis seems to protect from postoperative sepsis, septic shock and need for reoperation, it is likely that it is overused in rectal cancer surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.12248","type":"journal-article","created":{"date-parts":[[2013,4,16]],"date-time":"2013-04-16T03:01:03Z","timestamp":1366081263000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["The role of faecal diversion in low rectal cancer: a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma"],"prefix":"10.1111","volume":"15","author":[{"given":"S.","family":"Nurkin","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology Roswell Park Cancer Institute Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. R.","family":"Kakarla","sequence":"additional","affiliation":[{"name":"Department of Surgery New York Hospital Queens Weill Cornell Medical College Flushing New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. E.","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Department of Surgery New York Hospital Queens Weill Cornell Medical College Flushing New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. G.","family":"Cance","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Roswell Park Cancer Institute Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. I.","family":"Tiszenkel","sequence":"additional","affiliation":[{"name":"Department of Surgery New York Hospital Queens Weill Cornell Medical College Flushing New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,6,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318176bf65"},{"key":"e_1_2_8_3_1","first-page":"CD006878","article-title":"Covering ileo\u2010 or colostomy in anterior resection for rectal carcinoma","volume":"5","author":"Montedori A","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2005.03317.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2007.10.032"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002680020091"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-005-0734-1"},{"key":"e_1_2_8_8_1","first-page":"204","article-title":"Risk factors for anastomotic leakage after preoperative chemoradiation therapy and low anterior resection with total mesorectal excision for locally advanced rectal cancer","volume":"58","author":"Rodriguez\u2010Ramirez SE","year":"2006","journal-title":"Rev Invest Clin"},{"key":"e_1_2_8_9_1","unstructured":"American College of Surgeons \u2013 National Surgical Quality Improvement Program. 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