The prevalence and fate of the defunctioning stoma in patients with anal cancer: a regional experience following the ACT II trial

Abstract

The tumour features that are indications for defunctioning as advised by the UK IMRT guidelines are associated with a poorer overall outcome, and these stomas are less likely to be reversed. The majority of stomas, however, were formed for anterior tumours without infiltration into the vagina and were more likely to be successfully reversed.

Pretreatment colostomy in patients with anal squamous cell carcinoma: Risk factors for a permanent stoma

“…Previous studies have documented divergent results regarding the indications for and reversal rates of pretreatment stomas. The need for a colostomy ranges from 9% to 51%, and the reversal rates range from 5% to 48% 9–13 . Case series considering distinct numbers of patients with advanced tumors, less strict indications and cultural aspects may help to explain this discrepancy.…”

“…Common symptoms of anal SCC, such as anal pain or mild bleeding, usually improve with the initiation of CRT and are not considered a formal indication for colostomy. Poynter et al 12 evaluated the rationale for pretreatment stomas and concluded that patients with fecal incontinence, obstruction, or rectovaginal fistula were at higher risk of requiring a permanent stoma, while patients with less precise indications, such as anteriorly located tumors in women without clinically evident fistulas, were more likely to undergo reversal surgery. Of the 30 female patients with anteriorly located tumors, none of them developed a new fistula during CRT, so the need for a diversion does not seem justified.…”

“…The need for a colostomy ranges from 9% to 51%, and the reversal rates range from 5% to 48%. [9][10][11][12][13] Case series considering distinct numbers of patients with advanced tumors, less strict indications and cultural aspects may help to explain this discrepancy. Some series do not report the clinical stage specifically for this group of patients, 9,[11][12][13] while others do not report the rationale for the stoma, 11 making direct comparisons of the data difficult.…”

“…Limited data exist regarding the reversion of pretreatment stomas. The literature suggests that they are unlikely to be reverted, although the reported reversion rates range from 5% to 48% 9–13 . Heterogeneous populations, different indications for surgery, and cultural aspects regarding the acceptance of a stoma may explain these findings.…”

“…The literature suggests that they are unlikely to be reverted, although the reported reversion rates range from 5% to 48%. [9][10][11][12][13] Heterogeneous populations, different indications for surgery, and cultural aspects regarding the acceptance of a stoma may explain these findings. From a patient's perspective, retaining a pretreatment stoma after successful oncological treatment may be very frustrating.…”