Perineal pseudocontinent colostomy: an alternative method to promote patients’ satisfaction and safety?

A review of the advantages and disadvantages of perineal colostomy is interesting [1]. Within the community of colorectal surgeons, when one thinks of low-lying rectal cancer, undoubtedly, they consider the follow-up question: “How far from the sphincter?”. The above statement goes to show just how important sphincter-preserving techniques in rectal cancer surgery have become. However, dealing with cancerous growth is often a daunting task, and one that fails to conform with the surgeon’s expectations. Thus, while we utilize newer approaches for sphincter preservation, be it laparoscopic or robotic low anterior resection (LAS), recommending chemoradiation treatment to achieve sphincter preservation and seeking modern staplers that will allow for the most marginal anastomosis, there are a number of rectal cancer patients who are, unfortunately, not candidates for LAS. These patients, usually undergo total colonic and rectal excision, a procedure known as abdominoperineal resection (APR), which obliterates the natural anal orifice and results in the construction of a permanent abdominal ostomy.
It is evident that the quality of life (QoL) of such patients is greatly compromised when compared to their healthy control counterparts [2, 3]. In particular, ostomy creation seems to be related to diminished body image feelings among patients as well as adding further financial concerns for them, both of these closely related to the presence of an ostomy bag [4]. A comparison of APR with LAS patients further revealed that not only do the APR patients suffer the same anxiety and QoL reduction due to rectal cancer, but the treatment-specific subgroup also reported lower QoL scores specifically for body image and sexual problems, and was also more prone to constipation than patients in the LAS group [5]. A paired analysis between patients undergoing LAS and APR revealed that APR patients had significantly lower physical functioning scores and future perspective scores, as well as worse sexual participation and enjoyment scores [6]. A recent multicentre study also showcased worse long-term QoL scores, especially when sexual and urinary functionality were assessed [7]. Such results still disagree with other studies. However, none of them are match controlled. Nevertheless, while it is evident that a trend towards worse QoL in APR patients exists, more trials utilizing larger study populations are required to confirm these results [8, 9].
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