title: Stoma placement in obstructive rectal cancer prior to neo-adjuvant treatment and definitive surgery: A practical guideline.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Thomas.vermeer@catharinaziekenhuis.nl.
authors.forename: T A
authors.initials: TA
authors.lastname: Vermeer
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Ricardo.orsini@catharinaziekenhuis.nl.
authors.forename: R G
authors.initials: RG
authors.lastname: Orsini
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Grard.nieuwenhuijzen@catharinaziekenhuis.nl.
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: harm.rutten@catharina-ziekenhuis.nl.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: Freek.daams@catharinaziekenhuis.nl.
authors.forename: F
authors.initials: F
authors.lastname: Daams
mesh_terms: D000368:Aged; D000465:Algorithms; D057868:Anastomotic Leak / Q000209:etiology; D003125:Colostomy / Q000009:adverse effects* / Q000592:standards*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000592:standards; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D020360:Neoadjuvant Therapy; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors
keywords: Locally advanced; Locally recurrent; Neo-adjuvant treatment; Obstructive rectal cancer; Stoma