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Abstract

Aim: Low rectal cancer, within 6 cm of the anal verge commonly requires a permanent stoma but in selected patients a colo-anal anastomosis, with a defunctioning stoma is feasible. A restorative procedure is not complete until the defunctioning stoma is reversed. We report the reversal rate in 124 patients who had colo-anal anastomosis for low rectal cancer. Method: Two-hundred and seventy-two patients with low rectal cancer underwent surgery in the multicentre Low Rectal Cancer MERCURY II study: 96 females (35%); median age 65 years (range 23-89). Patient demographics, tumour stage, neoadjuvant treatment, stoma type, time to stoma closure and reason for non-reversal were recorded. Results: Low Anterior Resection was performed in 125/272 (46%) and each had a defunctioning ileostomy. In 101/125 (81%) the stoma was reversed at a median time of 166 (range 16-588) days. In 23/125(18%) the stoma was not reversed due to death (n = 2), metastasis (n = 2), local recurrence (n = 2), sepsis (n = 2), anastomotic leak (n = 3), anastomotic stenosis (n = 1), patient declined (n = 2), awaiting reversal (n = 1), conversion to colostomy (n = 2), other (n = 6). Conclusion: In a series of 272 patients with low rectal cancer, 125 had colo-anal anastomoses. In 18% the defunctioning stoma was not reversed. Restorative procedures for low rectal cancer have a high failure rate, this should be considered during the decision-making process and when consenting patients with low rectal cancer.

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