Risk Factors And Incidence For The Parastomal Hernia After Rectal Cancer Resection

Objective: The clinical and follow-up data of patients with permanent stoma after rectal cancer resection were retrospectively collected to analyse the incidence and risk factors of parastomal hernia(PSH).Methods: Retrospective collection and analysis of the clinical and follow-up data of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University.Inclusion criteria were clinical diagnosis of rectal cancer patients,abdominal perineal resection(APR)or Hartmann surgery,and a follow-up time of more than 40 months.During the postoperative follow-up,CT was reviewed to determine whether there was a PSH,and the relevant clinical variables of the patient were analyzed.Kaplan–Meier,and Cox multivariate analyses were used to evaluate related influencing factors,and morbidity of PSH.Results: Among the 211 rectal cancer patients,65 patients developed a parastomal hernia,with an incidence of 30.8%.The cumulative incidence of parastomal hernia ranged from10-28% at 12-40 months,reaching a maximum of 33.5% at 62 months.In the multivariate Cox survival analysis,the results showed that being a woman(HR 2.542;95% CI 1.544–4.186;P<0.001),aged ≥65 years(HR 2.411;95% CI 1.443–4.030;P=0.001),having a BMI ≥25 kg/m2(HR 1.933;95% CI 1.168–3.200;P=0.010),diabetes(HR 2.157 95% CI1.182–3.938;P=0.012),and Clavien-Dindo grade III and IV complications(HR 3.892;95% CI 1.831–8.275;P<0.001)were risk factors for the occurrence of PSH.Conclusion: The incidence of PSH increased annually,reaching a maximum cumulative incidence after 5 years.Among the patient-related factors,female,age ≥65 years,BMI≥25 kg/m2,diabetes and postoperative Clavien-Dindo grade III and IV complications were significantly associated with the development of PSH.Therefore,intervention measures to prevent patients with this risk factor are advisable.