The type of stoma matters—morbidity in patients with obstructing colorectal cancer

Abstract

Purpose

A loop colostomy may reduce the risk of severe intraabdominal complications in patients with obstructing colorectal cancer compared to an end colostomy. The aim of this study was to relate complications to the type of stoma, and a secondary aim was to evaluate whether the type of colostomy had an impact on time until oncological/surgical treatment.

Methods

All patients who underwent surgery and received a deviating colostomy due to obstructing colorectal cancer between January 2011 and December 2015 in five Swedish hospitals in Region Västra Götaland were included (n = 289). Patient charts were reviewed retrospectively. Patients alive in the end of 2016 were contacted and were sent a questionnaire including questions about stoma function and health-related quality of life.

Results

Some 289 patients were included; 147 received an end colostomy and 140 a loop colostomy. Two patients were excluded from the analysis due to missing data. There was no difference in complications at 90 days between the two groups, 44% (end colostomy) and 54% (loop colostomy) (odds ratio: 0.83 (95% CI: 0.49; 1.41). Time to start of treatment was similar in both groups. Patients with a loop colostomy had significantly higher stoma-related morbidity with retraction, prolapse, leakage and bandaging problems. No differences in quality of life were found.

Conclusion

The hypothesis that a loop colostomy reduced complications could not be confirmed. An end colostomy should be the first choice in these patients particularly in patients who will have their colostomy for the remainder of their life to reduce stoma-related symptoms.

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Authors

Corresponding author

Correspondence to Adiela Correa-Marinez.

Ethics declarations

Ethical considerations

This study has been approved by the ethical committee of Gothenburg EPN 412-15 and all patients included in the questionnaire part of the study gave informed consent.

Funding

Agreement concerning research and education of doctors, ALFGBG-493341 and 426501, VGRFoU and the Swedish Cancer Society CAN 2016/509.

Knut and Alice Wallenbergs Foundation.

Anna-Lisa och Bror Björnssons Foundation.

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Correa-Marinez, A., Grenabo, J., Bock, D. et al. The type of stoma matters—morbidity in patients with obstructing colorectal cancer. Int J Colorectal Dis 33, 1773–1780 (2018). https://doi.org/10.1007/s00384-018-3164-x

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Keywords

  • Diverting stoma
  • Colorectal tumour
  • Postoperative complications
  • Stoma complications
  • Quality of life