Objective To systematically review the incidence and risk factors of permanent stoma after temporary stoma in sphincter-preserving surgery for rectal cancer, and to provide evidence for the formulation of preventive intervention strategies.

Methods Databases including PubMed, The Cochrane Library, Embase, Web of Science, CINAHL, CNKI, VIP, and WanFang Data were electronically searched to collect relevant literature on the incidence and risk factors of permanent stoma after temporary stoma in sphincter-preserving surgery for rectal cancer from inception to June 18, 2026. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 and Stata 18.0 software.

Results A total of 18 studies involving 9,900 patients were included. Meta-analysis showed that the incidence of permanent stoma after temporary stoma was 17% [95%CI (15%, 19%)]. Risk factors included local recurrence [OR=7.11, 95%CI (3.49, 14.50)], anastomotic leakage [OR=6.58, 95%CI (4.32, 10.01)], postoperative complications [OR=3.26, 95%CI (2.10, 5.08)], stage IV disease [OR=2.72, 95%CI (1.56, 4.75)], age ≥65 years [OR=2.11, 95%CI (1.57, 2.83)], neoadjuvant chemoradiotherapy [OR=1.86, 95%CI (1.46, 2.37)] and American Society of Anesthesiologists (ASA) grade ≥ Ⅲ [OR=1.61, 95%CI (1.28, 2.03)].

Conclusion Local recurrence and anastomotic leakage are the highest risk factors for permanent stoma after temporary stoma in sphincter-preserving rectal cancer surgery, followed by postoperative complications, stage IV disease, age ≥ 65 years, neoadjuvant chemoradiotherapy, and ASA grade ≥ Ⅲ. Clinically, emphasis should be placed on enhancing anastomotic healing management, early intervention for postoperative complications, and monitoring of tumor recurrence to reduce the incidence of permanent stoma after temporary stoma.

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