Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;9(4):342.
doi: 10.21037/atm-21-29.

A nomogram to predict the incidence of permanent stoma in elderly patients with rectal cancer

Chuangkun Li  1   2 , Xiusen Qin  1   2 , Zifeng Yang  1   2 , Wentai Guo  1   2 , Rongkang Huang  1   2 , Huaiming Wang  1   2 , Hui Wang  1   2
Affiliations

A nomogram to predict the incidence of permanent stoma in elderly patients with rectal cancer

Chuangkun Li et al. Ann Transl Med. 2021 Feb.

Abstract

Background: Creation of a temporary diverting stoma during rectal cancer surgery is used widely to prevent undesirable outcomes related to anastomotic leakage (AL). The transition from temporary stoma (TS) to permanent stoma (PS) is a frequent outcome. Elderly patients may have a greater probability of PS. We aimed to identify risk factors of PS and developed a nomogram to predict the rate of PS for elderly patients.

Methods: We enrolled elderly patients (≥70 years) who underwent rectal cancer surgery with a TS between January 2014 and December 2017 at our hospital. We divided patients into two groups: a TS group and a PS group. We then identified the risk factors for PS and developed a nomogram to predict the possibility of PS.

Results: Of the 278 elderly patients who received a diverting stoma, 220 (79.14%) eventually underwent stoma reversal, and 58 (20.86%) had PS. The proportion of males in the PS group was significantly higher than that of the TS group (P=0.048). Univariate and multivariate analysis showed that American Society of Anesthesiologists (ASA) score (P<0.001), laparotomy (P=0.004), AL (P<0.001), and tumor recurrence (P<0.001) were significantly correlated with PS. These four factors were included to construct the nomogram. The consistency index of the nomogram was 0.833 and the model yielded an area under the curve of 0.833.

Conclusions: ASA score (≥3), laparotomy, AL, and tumor recurrence were independent risk factors for PS in elderly patients. Our nomogram exhibited moderate predictive ability.

Keywords: Rectal cancer; elderly patients; nomogram; permanent stoma.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-21-29). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart detailing the selection of the patients in this study.
Figure 2
Figure 2
Forest plot.
Figure 3
Figure 3
Nomogram for predicting permanent stoma (C-index: 0.833) after creation of a diverting stoma during rectal cancer surgery. The permanent stoma rate was estimated by adding the scores of anastomotic leakage, surgical method, ASA score, and tumor recurrence. ASA, American Society of Anesthesiologists.
Figure 4
Figure 4
Using the independent factors to developed ROC curve and a calibration curve. (A) ROC curve for the nomogram; AUC was 0.833 (95% CI =0.762–0.903). (B) Nomogram calibration curve. The y‐axis represents the actual probability of PS. The x‐axis represents the predicted PS probability. The ideal line represents a perfect prediction model. The apparent line represents the performance of the nomogram, and a close fit to the ideal line represents a good prediction. AUC, area under the curve; ROC, receiver operating characteristic.
See this image and copyright information in PMC

Comment in

References

    1. Gavriilidis P, Azoulay D, Taflampas P. Loop transverse colostomy versus loop ileostomy for defunctioning of col-orectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis. Surg Today 2019;49:108-17. 10.1007/s00595-018-1708-x - DOI - PubMed
    1. Zheng H, Wu Z, Wu Y, et al. Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer. Int J Colorectal Dis 2019;34:319-28. 10.1007/s00384-018-3199-z - DOI - PMC - PubMed
    1. Kim CW, Baek SJ, Hur H, et al. Anastomotic Leakage After Low Anterior Resection for Rectal Cancer Is Different Between Minimally Invasive Surgery and Open Surgery. Ann Surg 2016;263:130-7. 10.1097/SLA.0000000000001157 - DOI - PubMed
    1. Zhou X, Wang B, Li F, et al. Risk Factors Associated With Nonclosure of Defunctioning Stomas After Sphinc-ter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis. Dis Colon Rectum 2017;60:544-54. 10.1097/DCR.0000000000000819 - DOI - PubMed
    1. Rondelli F, Reboldi P, Rulli A, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009;24:479-88. 10.1007/s00384-009-0662-x - DOI - PubMed

LinkOut - more resources