Extraperitoneal sigmoidostomy: a surgical approach with less complications and better functions for abdominoperineal resection of rectal cancer.

Objective: The aim of this study is to explore the safety and function of extraperitoneal sigmoidostomy for patients with rectal cancer who underwent abdominoperineal resection.

Methods: We systematically reviewed records of patients with rectal cancer who underwent abdominoperineal resection and extraperitoneal or intraperitoneal sigmoidostomy from January 2010 to December 2014 at our department. They were grouped into the extraperitoneal (group A) and intraperitoneal sigmoidostomy (group B) groups. Clinical data were collected and statistically analyzed.

Results: A total of 231 consecutive cases were included: 108 cases in group A and 123 in group B. Patient demographics were similar in both groups. Group A was associated with less time for sigmoidostomy (19.6 ± 2.8 vs. 27.0 ± 4.5 min, p < 0.001), shorter postoperative hospitalization (6.4 ± 1.3 vs. 6.9 ± 1.6 days, p = 0.036), less incidence of stoma-related complications (p = 0.002) and less possibility of re-operation related to stomal complications (p = 0.037). Functions of stoma including stimulation of excrement, stimulating time for excrement, frequency of excrement, self-controlled ability of excrement, and regularity of excrement were all better than those in group B patients (p < 0.001, < 0.001, 0.018, 0.004, and 0.001, respectively). Patients in group A had less psychological problems including anxiety (p = 0.008), depression (p = 0.045), and impaired social interaction (p = 0.010).

Conclusions: Extraperitoneal sigmoidostomy is associated with shorter operative duration and postoperative hospitalization and has fewer complications and better outcome for abdominoperineal resection of rectal cancer, and patients also had less psychological problems.