Introduction Permanent stoma rate continues to be one of the quality indicators for rectal cancer management. National Bowel Cancer Audit 2013 annual report quotes a non-closure rate 30% or more of “temporary” stomas in rectal cancer surgery. This is considered to be reflective of poor quality of rectal cancer care.
Method A prospectively maintained data base of patients undergoing colorectal cancer resections in one of the large volume hospital trusts in the UK was analysed from 2011 to 2014 to assess the stoma rates, recanalisation and timings to reversal. The data base was verified against electronic records of radiology, endoscopy and clinic letters to ensure accuracy.
Results A total of 278 patients underwent curative surgery for rectal cancer. 207 had anterior resections (74.5%), 30 Hartmanns (10.7%) and 41 (14.8%) abdomino perineal resections. Overall 53.6 per cent of rectal cancer patients had a stoma at the time of a surgical resection. This included all cases of APER and Hartman’s but in addition 28.5 per cent of all anterior resections were covered by an ileostomy. Out of the ileostomies 52.5% were reversed. The mean time to reversal was 6 months (2–14 month). The mean time delay from clinic decision to contrast enema/endocopy and actual reversal were 34.5 days and 5 months respectively. The main reasons for delayed reversal were adjuvant chemotherapy and for non reversal was that patients were still awaiting reversal although they had been seen in clinic.
Conclusion Restorative resection rate per se(low permanent stoma rate) for low rectal cancers continues to be regarded as a national surrogate marker of surgical quality. An outcome audit is the best performance indicator for a colorectal unit. However, due consideration should be given to prevalence of ultra low rectal cancers, site of the tumour, preoperative poor sphincter function and patient fitness. Permanent stoma may not necessarily be a true depiction of quality of surgical care especially in the presence of MDT decisions where management plans are made preoperatively.
Disclosure of interest None Declared.
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