title: Ostomy function after abdominoperineal resection--a clinical and patient evaluation.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra campus, Gothenburg, Sweden. eva.angenete@vgregion.se
authors.forename: E
authors.initials: E
authors.lastname: Angenete
authors.forename: A
authors.initials: A
authors.lastname: Correa-Marinez
authors.forename: J
authors.initials: J
authors.lastname: Heath
authors.forename: E
authors.initials: E
authors.lastname: González
authors.forename: A
authors.initials: A
authors.lastname: Wedin
authors.forename: M
authors.initials: M
authors.lastname: Prytz
authors.forename: D
authors.initials: D
authors.lastname: Asplund
authors.forename: E
authors.initials: E
authors.lastname: Haglind
mesh_terms: D000005:Abdomen / Q000503:physiopathology* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004766:Enterostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000503:physiopathology* / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires