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Risk Factors of Poor Functional Results at 1-Year After Pseudocontinent Perineal Colostomy for Ultralow Rectal Adenocarcinoma

Souadka, Amine M.D.1; Majbar, Mohammed Anass M.D.2; Bougutab, Abdeslam M.D.1; El Othmany, Azzedine M.D.1; Jalil, Abdelouahed M.D.1; Ahyoud, Fatema Zahra M.D.1; El Malki, Hadj Omar M.D.3,4; Souadka, Abdelilah M.D.1,5

doi: 10.1097/DCR.0b013e31829f8cd5
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: Pseudocontinent perineal colostomy is one of the techniques that helps recover the body image of patients undergoing abdominoperineal resection. This technique is rarely used internationally given its unknown functional results.

OBJECTIVE: The study aimed to evaluate 1-year functional outcomes of perineal pseudocontinent colostomy and to determine the risk factors for “poor” functional results.

DESIGN: This study is a retrospective interventional case series.

SETTINGS: This study was conducted at a tertiary care university hospital and oncological center in Morocco.

PATIENTS: From January 1993 to December 2007, 149 patients underwent pseudocontinent perineal colostomy after abdominoperineal resection for low rectal adenocarcinoma.

INTERVENTION: Pseudocontinent perineal colostomy was performed with the use of the Schmidt technique after abdominoperineal resection.

MAIN OUTCOME MEASURES: One-year functional results were assessed according to the Kirwan classification system. Functional results were considered “poor” when the Kirwan score was C, D, or E. Univariable and multivariable analyses were used to evaluate the impact of age, sex, type of surgery, irrigation frequency, palpable muscular ring, concomitant chemoradiotherapy, stage, and perineal complications on functional results.

RESULTS: One hundred forty-six patients were analyzed. According to the Kirwan system, the scores showed that 100 (68.5%) patients had “good” continence results (stage A-B) and 46 (31.5%) patients had altered functional results (stage C-D-E). With the exception of pelvic recurrences, no conversions from a perineal colostomy to an abdominal colostomy were performed for dissatisfactory functional results. In multivariate analysis, the only independent predictive factors of poor functional results were the occurrence of perineal complications (OR, 3.923; 95% CI, 1.461–10.35; p = 0.007) and extended resection (OR, 3.03; 95% CI, 1.183–7.750; p = 0.021)

LIMITATION OF THE STUDY: This study is an observational retrospective study on selected patients (mainly a young population).

CONCLUSIONS: This study showed that perineal complications and extended resection are associated with poor functional results after pseudocontinent perineal colostomy. These data can help clinicians to better inform patients about the outcomes of this technique and to assist them in choosing the right reconstruction technique after abdominoperineal resection.

1 University Mohammed Vth Souissi, Rabat, Medical School, Surgical Department, National Institute of Oncology, Rabat, Morocco

2 University Mohammed Vth Souissi, Rabat, Medical School, Department of General Surgery, Rabat, Morocco

3 University Mohammed Vth Souissi, Rabat, Medical School, Medical Center of Clinical Trials and Epidemiological Study (CRECET), Rabat, Morocco

4 Cheikh Zaid Ibn Soltan Foundation, Cheikh Zaid International University Hospital, Rabat, Morocco

5 Surgical Department, Al Azhar Oncological Center, Rabat, Morocco

Financial Disclosure: None reported.

Correspondence: Amine Souadka, M.D., Surgical department, National Institute of Oncology, Rabat, Morocco. E-mail: souadka@gmail.com

© 2013 The American Society of Colon and Rectal Surgeons