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2010 Annual Meeting Abstracts

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Do Older Americans Undergo Stoma Reversal Following Low Anterior Resection for Rectal Cancer?
*Christopher Dodgion1, *Bridget Neville2, *Stuart Lipsitz1, *Deborah Schrag2, *Caprice Greenberg1
1Brigham and Women's Hospital, Boston, MA;2Dana Farber Cancer Institute, Boston, MA

Objective: Evaluate rates, timing and likelihood of stoma reversal. Design/Setting: Large retrospective population-based cohort study of SEER-Medicare. Patients: 1026 primary stage I-III rectal cancer patients diagnosed 1991 - 2005 and undergoing low anterior resection (LAR) with creation of a diverting stoma. Main Outcome Measures: Proportion of patients who had stoma reversal within 18 months of primary resection. Patient, clinical and hospital characteristics were included in a multivariable logistic regression model with random hospital effects to determine likelihood of reversal. A Cox proportional hazard model was fit for time to reversal. Results: Within 18 months of LAR, 52% (532/1026) of patients underwent stoma reversal. Patients were more likely to have their stoma reversed if they were <80 years old [OR 2.9 (95% CI 2.2, 4.0)], had no comorbidities [OR 1.6 (95% CI 1.3, 2.1)], lower tumor stage [1 vs. 3; OR 2.1 (95% CI 1.4, 3.3)], received neoadjuvant radiation [OR 2.9 (95% CI 2.1, 4.0)], and were married [OR 1.5 (95% CI 1.2, 2.0)]. Additionally, patients treated at an NCI center [OR 1.9 (95% CI 1.1, 3.5)] or a for profit hospital [vs non-profit or government; OR 1.8 (95% CI 1.1, 2.9)], were more likely to undergo stoma reversal. Median time to reversal was 242 days (95% CI: 211-288). Shorter time to reversal was associated with younger age (p<.0001), lower tumor stage (p<.0001), receipt of neoadjuvant radiation (p<.0001), and rectal tumor location (vs. rectosigmoid, p=0.013). Conclusions: Over half of rectal cancer patients >=65 who undergo sphincter-sparing surgery with temporary stoma have not undergone stoma reversal by 18 months. Identifiable risk factors predict both delay and non-reversal. This information is critical for pre-operative discussions.

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