{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T06:22:33Z","timestamp":1760077353152},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2014,3,14]],"date-time":"2014-03-14T00:00:00Z","timestamp":1394755200000},"content-version":"vor","delay-in-days":0,"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":[[2014,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The latest <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ational <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>owel <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ancer <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>udit <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>rogramme (<jats:styled-content style=\"fixed-case\">NBOCAP<\/jats:styled-content>) audit identified our colorectal unit as an outlier with regard to the high permanent stoma rate. The aim of this study was to perform an audit of the rationale for stoma formation in patients undergoing rectal cancer resection in our unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A review was conducted of all rectal cancer operations between <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril 2011 and <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>arch 2013. Preoperative staging investigations and operation reports were reviewed to identify the reasons for nonrestorative surgery. Postoperative histology reports were used to identify circumferential resection margin (<jats:styled-content style=\"fixed-case\">CRM<\/jats:styled-content>) involvement and tumour height.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One\u2010hundred and twenty\u2010five patients underwent surgery for rectal cancer, of whom 102 underwent elective resection with curative intent. The permanent stoma rate was 63.2% when emergency and palliative procedures were included and 54.9% when only elective curative cases were considered. Tertiary referrals made up 31.4% of elective cases. The main reasons for nonrestorative surgery included multivisceral resection (<jats:italic>n<\/jats:italic>\u00a0=\u00a024) for locally advanced cancer and operations for lesions close to the anal sphincter (<jats:italic>n<\/jats:italic>\u00a0=\u00a021). The median length of stay was 8\u00a0days, the 90\u2010day mortality was 2.9% and the rate of <jats:styled-content style=\"fixed-case\">CRM<\/jats:styled-content> involvement was 2.0%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our unit provides multivisceral surgery for locally advanced rectal cancer and receives a substantial number of tertiary referrals. Many of the rectal cancers referred are locally advanced or threaten the anal sphincter. This study demonstrates that the complexity of a unit's case\u2010mix can have a profound effect on the permanent stoma rate. Stoma rates taken at face value do not therefore provide an accurate representation of surgical quality.<\/jats:p><\/jats:sec><jats:sec><jats:label \/><jats:p>\n<jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:caption><jats:title>What does this paper add to the literature?<\/jats:title><\/jats:caption><jats:p>The study reviews the practice of a colorectal surgical unit with an interest in multivisceral surgery with regard to the permanent stoma rate. The reasons for nonrestorative surgery are analysed, and the problems associated with the use of stoma rates as a marker of quality in colorectal surgery are highlighted.<\/jats:p><\/jats:boxed-text>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.12509","type":"journal-article","created":{"date-parts":[[2013,12,4]],"date-time":"2013-12-04T11:12:31Z","timestamp":1386155551000},"page":"276-280","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Permanent stoma rates: a misleading marker of quality in rectal cancer surgery"],"prefix":"10.1111","volume":"16","author":[{"given":"R. J.","family":"Codd","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Singleton Hospital Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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P.","family":"Khot","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singleton Hospital Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. R.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singleton Hospital Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Beynon","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singleton Hospital Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,3,14]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Healthcare Quality Improvement Partnership (HQIP).2013.National Bowel Cancer Audit Programme (NBOCAP). 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