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.
Overview of evidence (non-systematic literature review)[edit source]
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.
There is evidence that patients have a better quality of life postoperatively if their stoma is sited preoperatively by a stomal therapist, aand that these patients will have fewer stoma-related complications.
Stomal therapists are able to provide counselling, education and support, and can even facilitate patients talking to other patients with stomas.
Patients undergoing colorectal cancer surgery who may, or will, require a stoma should be seen prior to surgery by a stomal therapist.
Patients with stomas should be given postoperative education.
- 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 Colon Rectum 1997 Apr;40(4):440-2 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9106693.
- 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 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26727684.
- 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 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24807019.
- 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 Colon Rectum 2012 Jul;55(7):783-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22706131.
- Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum 1999;42: 1569-74.