Stoma placement in obstructive rectal cancer prior to neo-adjuvant treatment and definitive surgery: A practical guideline

• Published in: European journal of surgical oncology Vol. 42; no. 2; pp. 273 - 280
• Main Authors: Vermeer, T.A, Orsini, R.G, Nieuwenhuijzen, G.A.P, Rutten, H.J.T, Daams, F
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2016
• Subjects: Aged; Algorithms; Anastomotic Leak - etiology; Colostomy - adverse effects; Colostomy - standards; Female; Hematology, Oncology and Palliative Medicine; Humans; Ileostomy - adverse effects; Ileostomy - standards; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Locally advanced; Locally recurrent; Male; Neo-adjuvant treatment; Neoadjuvant Therapy; Obstructive rectal cancer; Practice Guidelines as Topic; Rectal Neoplasms - complications; Rectal Neoplasms - surgery; Rectal Neoplasms - therapy; Reoperation; Retrospective Studies; Stoma; Surgery; Time Factors; Obstructive rectal cancer; Stoma; Locally recurrent; Locally advanced; Neo-adjuvant treatment
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2015.11.008

Abstract Introduction Mechanical bowel obstruction in rectal cancer is a common problem, requiring stoma placement to decompress the colon and permit neo-adjuvant treatment. The majority of patients operated on in our hospital are referred; after stoma placement at the referring centre without overseeing final type of surgery. Stoma malpositioning and its effects on rectal cancer care are described. Methods All patients who underwent surgery for locally advanced or locally recurrent rectal cancer between 2000 and 2013 in our tertiary referral centre were reviewed and included if they received a stoma before curative surgery. Patients with recurrent rectal cancer were only included if the stomas from the primary surgery had been restored. The main outcome measures are stoma malpositioning, postoperative and stoma-related complications. Results A total of 726 patients were included; of these, 156 patients (21%) had a stoma before curative surgery. In the majority of patients, acute or pending large bowel obstruction was the main indication for emergent stoma creation; some of the patients had tumour-related fistulae. In 53 patients (34%), the stoma required revision during definitive surgery. No significant differences were found regarding postoperative complications. Conclusion One-third of the previously placed emergency stomas were considered to be located inappropriately and required revision. We were able to avoid increased complication rates in patients with a malpositioned stoma, however unnecessary surgery for an inappropriately placed stoma should be avoided to decrease patient inconvenience and risks. An algorithm is proposed for the placement of a suitable stoma.