Stomal therapy

From Cancer Guidelines Wiki

Background

Patients undergoing surgery for colorectal cancer, both in elective and emergency settings, may require a stoma. This includes formation of a permanent colostomy in patients with low rectal cancers; construction of ileostomies or colostomies in patients with an obstructing cancer, where an anastomosis is not appropriate; and formation of a temporary diverting loop stoma proximal to an anastomosis.

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Overview of evidence (non-systematic literature review)

No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.

Patients having surgery for colorectal cancer who definitely require a stoma, or who may require a stoma, should be seen by a stomal therapy nurse prior to surgery, and have the appropriate possible site/s for a stoma marked on their abdomen.[1]

There is evidence that patients have a better quality of life postoperatively if their stoma is sited preoperatively by a stomal therapist,[2] aand that these patients will have fewer stoma-related complications.[3][4]

Stomal therapists are able to provide counselling, education and support, and can even facilitate patients talking to other patients with stomas.[5]
Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.Question mark transparent.png

Patients undergoing colorectal cancer surgery who may, or will, require a stoma should be seen prior to surgery by a stomal therapist.

Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.Question mark transparent.png

Patients with stomas should be given postoperative education.


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References

  1. Bass EM, Del Pino A, Tan A, Pearl RK, Orsay CP, Abcarian H. Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis ColonThe main part of the large bowel, which absorbs water and electrolytes from undigested food (solid waste). Its four parts are the ascending colon, transverse colon, descending colon and sigmoid colon. RectumThe final section of the large bowel, ending at the anus. 1997 Apr;40(4):440-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9106693.
  2. McKenna LS, Taggart E, Stoelting J, Kirkbride G, Forbes GB. The Impact of Preoperative Stoma Marking on Health-Related Quality of Life: A Comparison Cohort Study. J Wound Ostomy Continence Nurs 2016 Jan;43(1):57-61 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26727684.
  3. Baykara ZG, Demir SG, Karadag A, Harputlu D, Kahraman A, Karadag S, et al. A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and peristomal complications. Ostomy Wound Manage 2014 May;60(5):16-26 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24807019.
  4. Person B, Ifargan R, Lachter J, Duek SD, Kluger Y, Assalia A. The impact of preoperative stoma site marking on the incidence of complications, quality of life, and patient's independence. Dis ColonThe main part of the large bowel, which absorbs water and electrolytes from undigested food (solid waste). Its four parts are the ascending colon, transverse colon, descending colon and sigmoid colon. RectumThe final section of the large bowel, ending at the anus. 2012 Jul;55(7):783-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22706131.
  5. Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis ColonThe main part of the large bowel, which absorbs water and electrolytes from undigested food (solid waste). Its four parts are the ascending colon, transverse colon, descending colon and sigmoid colon. RectumThe final section of the large bowel, ending at the anus. 1999;42: 1569-74.
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