Ostomy function after abdominoperineal resection—a clinical and patient evaluation

Abstract

Purpose

Abdominoperineal resection (APR) for rectal cancer results in a permanent colostomy. As a consequence of a recent change in operative technique from standard (S-APR) to extralevator resection (E-APR), the perineal part of the procedure is now performed with the patient in a prone jackknife position. The impact of this change on stoma function is unknown. The aim was to determine stoma-related complications and the individual patient experience of a stoma.

Methods

Consecutive patients with rectal cancer operated on with APR in one institution in 2004 to 2009 were included. Recurrent cancer, palliative procedures, pre-existing stoma and patients not alive at the start of the study were excluded. Data were collected from hospital records and the national colorectal cancer registry. A questionnaire was sent out to patients. The median follow-up was 44 months (13–84) after primary surgery.

Results

Ninety-six patients were alive in February 2011. Seventy seven agreed to participate. Sixty-nine patients (90 %) returned the questionnaire. Stoma necrosis was more common for E-APR, 34 % vs. 10 %, but bandaging problems and low stoma height were more common for S-APR. There were no differences in the patients' experience of stoma function. In all, 35 % of the patients felt dirty and unclean, but 90 % felt that they had a full life and could engage in leisure activities of their choice.

Conclusions

This exploratory study indicates no difference in stoma function after 1 year between S-APR and E-APR. Over 90 % of the patients accept their stoma, but our study indicates that more information and support for patients are warranted.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341(8843):457–460

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Valentini V, Aristei C, Glimelius B, Minsky BD, Beets-Tan R, Borras JM, Haustermans K, Maingon P, Overgaard J, Pahlman L, Quirke P, Schmoll HJ, Sebag-Montefiore D, Taylor I, Van Cutsem E, Van de Velde C, Cellini N, Latini P (2009) Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiother Oncol 92(2):148–163. doi:10.1016/j.radonc.2009.06.027

    PubMed  Article  Google Scholar 

  3. 3.

    Pahlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjodahl R, Ojerskog B, Damber L, Johansson R (2007) The Swedish Rectal Cancer Registry. Br J Surg 94(10):1285–1292

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701

    PubMed  Article  Google Scholar 

  5. 5.

    Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23(36):9257–9264. doi:10.1200/JCO.2005.02.9231

    PubMed  Article  Google Scholar 

  6. 6.

    den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF, Rodel C, Bujko K, Pahlman L, van de Velde CJ (2009) The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 45:1175–1183

    Article  Google Scholar 

  7. 7.

    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):232–238

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    West NP, Anderin C, Smith KJ, Holm T, Quirke P (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97(4):588–599. doi:10.1002/bjs.6916

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Stelzner S, Koehler C, Stelzer J, Sims A, Witzigmann H (2011) Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer—a systematic overview. Int J Colorectal Dis. doi:10.1007/s00384-011-1235-3

  10. 10.

    Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ (2010) Complications of intestinal stomas. Br J Surg. doi:10.1002/bjs.7259

  11. 11.

    Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Colorectal Dis 12(10):958–964. doi:10.1111/j.1463-1318.2009.02006.x

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Persson E, Berndtsson I, Carlsson E, Hallen AM, Lindholm E (2010) Stoma-related complications and stoma size—a 2-year follow up. Colorectal Dis 12(10):971–976. doi:10.1111/j.1463-1318.2009.01941.x

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Cottam J, Richards K, Hasted A, Blackman A (2007) Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 9(9):834–838. doi:10.1111/j.1463-1318.2007.01213.x

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Shellito PC (1998) Complications of abdominal stoma surgery. Dis Colon Rectum 41(12):1562–1572

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Lian L, Wu XR, He XS, Zou YF, Wu XJ, Lan P, Wang JP (2011) Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Colorectal Dis. doi:10.1007/s00384-011-1293-6

  16. 16.

    Sjodahl R, Anderberg B, Bolin T (1988) Parastomal hernia in relation to site of the abdominal stoma. Br J Surg 75(4):339–341

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    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):1099–1106. doi:10.1245/s10434-007-9748-2

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Wilson TR, Alexander DJ (2008) Clinical and non-clinical factors influencing postoperative health-related quality of life in patients with colorectal cancer. Br J Surg 95(11):1408–1415. doi:10.1002/bjs.6376

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    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):669–677. doi:10.1007/DCR.0b013e31819eb970

    PubMed  Article  Google Scholar 

  20. 20.

    Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238(2):203–213. doi:10.1097/01.sla.0000080823.38569.b0

    PubMed  Google Scholar 

  21. 21.

    Sprangers MA, Taal BG, Aaronson NK, te Velde A (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38(4):361–369

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    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):1295–1303. doi:10.1002/bjs.7105

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    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):2056–2068. doi:10.1245/s10434-007-9402-z

    PubMed  Article  Google Scholar 

  24. 24.

    Pachler J, Wille-Jorgensen P (2005) Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2:CD004323. doi:10.1002/14651858.CD004323.pub3

    PubMed  Google Scholar 

  25. 25.

    Bloemen JG, Visschers RG, Truin W, Beets GL, Konsten JL (2009) Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma. Dis Colon Rectum 52(7):1251–1258. doi:10.1007/DCR.0b013e3181a74322

    PubMed  Article  Google Scholar 

  26. 26.

    Fisher SE, Daniels IR (2006) Quality of life and sexual function following surgery for rectal cancer. Colorectal Dis 8(Suppl 3):40–42. doi:10.1111/j.1463-1318.2006.01071.x

    PubMed  Article  Google Scholar 

  27. 27.

    Kasparek MS, Hassan I, Cima RR, Larson DR, Gullerud RE, Wolff BG (2010) Quality of life after rectal excision and coloanal anastomosis for distal rectal cancers: sphincter preservation versus quality of life. Colorectal Dis. doi:10.1111/j.1463-1318.2010.02347.x

  28. 28.

    Asplund D, Haglind E, Angenete E (2012) Outcome of extralevator abdominoperineal excision compared with standard surgery. Results from a single centre. Colorectal Dis. doi:10.1111/j.1463-1318.2012.02930.x

  29. 29.

    Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ, Holmberg L (2002) Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347(11):790–796. doi:10.1056/NEJMoa021483

    PubMed  Article  Google Scholar 

  30. 30.

    Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP (2002) Stoma complications: a multivariate analysis. Am Surg 68(11):961–966, Discussion 966

    PubMed  Google Scholar 

  31. 31.

    Del Pino A, Cintron JR, Orsay CP, Pearl RK, Tan A, Abcarian H (1997) Enterostomal complications: are emergently created enterostomas at greater risk? Am Surg 63(7):653–656

    PubMed  Google Scholar 

  32. 32.

    Camilleri-Brennan J, Steele RJ (2001) Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg 88(12):1617–1622. doi:10.1046/j.0007-1323.2001.01933.x

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Kreicbergs U, Valdimarsdottir U, Steineck G, Henter JI (2004) A population-based nationwide study of parents' perceptions of a questionnaire on their child's death due to cancer. Lancet 364(9436):787–789. doi:10.1016/S0140-6736(04)16939-0

    PubMed  Article  Google Scholar 

Download references

Funding

This study received funding from the Assar Gabrielsson Foundation, the Swedish Society of Medicine, the Gothenburg Medical Society and the Swedish Cancer Foundation, Sahlgrenska University Hospital (ALF).

Disclaimer

None of the authors have any conflicts of interest.

Author information

Affiliations

Authors

Corresponding author

Correspondence to E. Angenete.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Angenete, E., Correa-Marinez, A., Heath, J. et al. Ostomy function after abdominoperineal resection—a clinical and patient evaluation. Int J Colorectal Dis 27, 1267–1274 (2012). https://doi.org/10.1007/s00384-012-1463-1

Download citation

Keywords

  • Ostomy
  • Rectal cancer
  • Abdominoperineal excision
  • Quality of life