International Journal of Colorectal Disease

, Volume 31, Issue 3, pp 635–641 | Cite as

Stoma-related symptoms in patients operated for rectal cancer with abdominoperineal excision

  • Adiela Correa Marinez
  • Elisabeth González
  • Kajsa Holm
  • David Bock
  • Mattias Prytz
  • Eva Haglind
  • Eva Angenete
Original Article



The primary aim of this study was to characterize the frequency, severity, and distress of symptoms from the colostomy and colostomy acceptance in rectal cancer patients. The secondary aims were to study the symptomatic parastomal herniation, its relationship to stoma-related symptoms, and potential risk factors for the development of symptomatic parastomal herniation.


Data was collected from the Swedish Colorectal Cancer Registry and from surgical charts. Patients operated for rectal cancer with an abdominoperineal excision in Sweden between 2007 and 2009 and alive 3 years postoperatively were contacted (n = 852). Patients who consented to participate, had a colostomy constructed during the abdominoperineal excision, and who answered a questionnaire 3 years postoperative were included (n = 495). Answers were analyzed with emphasis on stoma-related symptoms and their intensity as well as the level of distress associated with the symptoms.


Almost 90 % of patients did not feel limited in their daily life by their colostomy. Patients with symptomatic parastomal hernia had a 53 % higher risk of flatulence. Fifty-six patients developed symptomatic parastomal hernia (11 %). The only risk factor associated with the development of symptomatic parastomal hernia was high body mass index (BMI).


This study shows that most patients do not feel limited by their stoma 3 years after surgery for rectal cancer. Symptomatic parastomal hernia was associated with high BMI but not with the surgical technique.


Rectal neoplasm Stoma Parastomal hernia Quality of life 


  1. 1.
    Miles WE (1971) A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin 21(6):361–364CrossRefPubMedGoogle Scholar
  2. 2.
    Holm T, Ljung A, Haggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–238CrossRefPubMedGoogle Scholar
  3. 3.
    Hoerske C, Weber K, Goehl J, Hohenberger W, Merkel S (2010) Long-term outcomes and quality of life after rectal carcinoma surgery. Br J Surg 97(8):1295–1303CrossRefPubMedGoogle Scholar
  4. 4.
    Cornish JA, Tilney HS, Heriot AG, Lavery IC, Fazio VW, Tekkis PP (2007) A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Ann Surg Oncol 14(7):2056–2068CrossRefPubMedGoogle Scholar
  5. 5.
    Pachler J, Wille-Jorgensen P (2005) Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev (2):Cd004323Google Scholar
  6. 6.
    Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15(4):1099–1106CrossRefPubMedGoogle Scholar
  7. 7.
    Yau T, Watkins D, Cunningham D, Barbachano Y, Chau I, Chong G (2009) Longitudinal assessment of quality of life in rectal cancer patients with or without stomas following primary resection. Dis Colon Rectum 52(4):669–677CrossRefPubMedGoogle Scholar
  8. 8.
    Vonk-Klaassen SM, de Vocht HM, den Ouden ME, Eddes EH, Schuurmans MJ (2015) Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life ResGoogle Scholar
  9. 9.
    Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37(9):916–920CrossRefPubMedGoogle Scholar
  10. 10.
    Shellito PC (1998) Complications of abdominal stoma surgery. Dis Colon Rectum 41(12):1562–1572CrossRefPubMedGoogle Scholar
  11. 11.
    Carne PWG, Frye JNR, Robertson GM, Frizelle FA (2003) Parastomal hernia following minimally invasive stoma formation. ANZ J Surg 73(10):843–845CrossRefPubMedGoogle Scholar
  12. 12.
    Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ (2010) Complications of intestinal stomas. Br J Surg 97(12):1885–1889CrossRefPubMedGoogle Scholar
  13. 13.
    Arumugam PJ, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J et al (2003) A prospective audit of stomas—analysis of risk factors and complications and their management. Colorectal Dis Off J Assoc Coloproctology Great Britain Ireland 5(1):49–52CrossRefGoogle Scholar
  14. 14.
    Israelsson LA (2005) Preventing and treating parastomal hernia. World J Surg 29(8):1086–1089CrossRefPubMedGoogle Scholar
  15. 15.
    Janes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91(3):280–282CrossRefPubMedGoogle Scholar
  16. 16.
    López-Cano M, Lozoya-Trujillo R, Quiroga S, Sánchez JL, Vallribera F, Martí M et al (2012) Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 16(6):661–667CrossRefPubMedGoogle Scholar
  17. 17.
    Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J (2009) Randomized, controlled, prospective trial of the use of mesh to prevent parastomal hernia. Dis Colon Rectum 52(9):1676Google Scholar
  18. 18.
    Tam KW, Wei PL, Kuo LJ, Wu CH (2010) Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 34(11):2723–2729CrossRefPubMedGoogle Scholar
  19. 19.
    van Dijk SM, Timmermans L, Deerenberg EB, Lamme B, Kleinrensink GJ, Jeekel J et al (2015) Parastomal hernia: impact on quality of life? World J Surg 39(10):2595–2601CrossRefPubMedGoogle Scholar
  20. 20.
    North J (2014) Early intervention, parastomal hernia and quality of life: a research study. Br J Nurs 23(5):S14–S18CrossRefPubMedGoogle Scholar
  21. 21.
    Feddern ML, Emmertsen KJ, Laurberg S (2015) Life with a stoma after curative resection for rectal cancer. A population-based, cross-sectional study. Colorectal Dis Off J Assoc Coloproctology Great Britain IrelandGoogle Scholar
  22. 22.
    Lian L, Wu XR, He XS, Zou YF, Wu XJ, Lan P et al (2012) Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Color Dis 27(1):59–64CrossRefGoogle Scholar
  23. 23.
    Sjodahl R, Anderberg B, Bolin T (1988) Parastomal hernia in relation to site of the abdominal stoma. Br J Surg 75(4):339–341CrossRefPubMedGoogle Scholar
  24. 24.
    Ortiz H, Sara MJ, Armendariz P, de Miguel M, Marti J, Chocarro C (1994) Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall? Int J Color Dis 9(2):65–67CrossRefGoogle Scholar
  25. 25.
    Nguyen MH, Pittas F (1999) How large should a skin trephine be for an end stoma? Aust N Z J Surg 69(9):675–676CrossRefPubMedGoogle Scholar
  26. 26.
    Resnick S (1986) New method of bowel stoma formation. Am J Surg 152(5):545–548CrossRefPubMedGoogle Scholar
  27. 27.
    Prytz M, Angenete E, Bock D, Haglind E (2015) Extralevator abdominoperineal excision for low rectal cancer-extensive surgery to be used with discretion based on 3-year local recurrence results: a registry-based, Observational National Cohort Study. Ann SurgGoogle Scholar
  28. 28.
    Prytz M, Angenete E, Ekelund J, Haglind E (2014) Extralevator abdominoperineal excision (ELAPE) for rectal cancer—short-term results from the Swedish Colorectal Cancer Registry. Selective use of ELAPE warranted. Int J Color Dis 29(8):981–987CrossRefGoogle Scholar
  29. 29.
    Asplund D, Prytz M, Bock D, Haglind E, Angenete E (2015) Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer. Int J Colorectal DisGoogle Scholar
  30. 30.
    Asplund D, Heath J, Gonzalez E, Ekelund J, Rosenberg J, Haglind E et al (2014) Self-reported quality of life and functional outcome in patients with rectal cancer—QoLiRECT. Dan Med J 61(5):A4841PubMedGoogle Scholar
  31. 31.
    Angenete E, Correa-Marinez A, Heath J, Gonzalez E, Wedin A, Prytz M et al (2012) Ostomy function after abdominoperineal resection—a clinical and patient evaluation. Int J Color Dis 27(10):1267–1274CrossRefGoogle Scholar
  32. 32.
    Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ et al (2002) Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347(11):790–796CrossRefPubMedGoogle Scholar
  33. 33.
    Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G (1999) Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 340(18):1383–1389CrossRefPubMedGoogle Scholar
  34. 34.
    Zou G (2004) A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706CrossRefPubMedGoogle Scholar
  35. 35.
    Burch J (2007) Constipation and flatulence management for stoma patients. Br J Community Nurs 12(10):449–452CrossRefPubMedGoogle Scholar
  36. 36.
    Evans MD, Williams GL, Stephenson BM (2009) Preventing parastomal herniation: is prophylactic prosthetic mesh absolutely necessary? World J Surg 33(7):1538–1539, author reply 40-1CrossRefPubMedGoogle Scholar
  37. 37.
    Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP (2002) Stoma complications: a multivariate analysis. Am Surg 68(11):961–966, discussion 6PubMedGoogle Scholar
  38. 38.
    Janes A, Cengiz Y, Israelsson LA (2010) Experiences with a prophylactic mesh in 93 consecutive ostomies. World J Surg 34(7):1637–1640CrossRefPubMedGoogle Scholar
  39. 39.
    Janes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33(1):118–121, discussion 22-3CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Surgery, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/ÖstraGothenburgSweden
  2. 2.Department of SurgeryNU-hospital GroupTrollhättanSweden

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