Observational Study
Copyright ©The Author(s) 2020.
World J Gastroenterol. Feb 28, 2020; 26(8): 850-864
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.850
Table 1 Demographics and characteristics
VariableDiverting colostomy, n = 14Conservative treatment, n = 25Colostomy vs conservative, P valueITT group, n = 50ITT group vs colostomy, P value
Age, mean ± SD61 ± 10.960.2 ± 2.40.8959.3 ± 8.70.767
Sex, female/male13/123/21.0149/11.01
Primary cancer0.4050.879
Cervical cancer122145
Endometrial cancer022
Rectal cancer212
Prostate cancer011
Radiation dosage, Gy82 ± 15.983.6 ± 20.50.82583.4 ± 18.50.553
Duration of bleeding in mo13 ± 4.38.0 ± 1.80.04211.3 ± 4.00.263
Pre-Op transfusion, yes/no12/26/19< 0.001--
Pre-Op Hb, g/L (lowest level)63 ± 17.888.2 ± 19.3< 0.00180 ± 27.80.051
Bleeding remission rate
Post-Op 3 mo12/14 (86%)1/25 (4%)< 0.001--
Post-Op 6 mo12/14 (86%)3/25 (12%)< 0.001--
Post-Op 9 mo13/14 (93%)5/25 (20%)< 0.001--
Post-Op 1 yr14/14 (100%)6/25 (24%)< 0.001--
Post-Op 2 yr14/14 (100%)5/25 (20%)< 0.001--
Bleeding score at initial diagnosis2.7 ± 0.52.0 ± 0.5< 0.001--
Bleeding score after 1 yr of treatment0.8 ± 0.51.7 ± 0.90.0082.4 ± 0.50.033
Table 2 Clinical details and outcomes of 14 colostomy patients
CharacteristicCase
Median(range or %)
1234567891011121314
Age708349485972587356476368465961 (47-83)
SexFFFFFFMFFFFFFF13 (F, 93%)
Primary cancerCervixCervixCervixCervixCervixCervixRectumCervixCervixAnusCervixCervixCervixCervix12 (Cervix, 86%)
Radiation dosage, Gy9880966080785080808486741208082 (50-120)
Duration of bleeding in mo191514211518871510108111013 (7-21)
Pre-Op transfusion (U)5842484-42222-12 (Yes, 86%)
Duration of stoma in mo483418103492615125310151416 (9-53)
Indication(s) for colostomySevere anemiaSevere anemiaSevere anemiaSevere anemiaSevere anemiaSevere anemiaSevere anemiaModerate anemia + perianal painSevere anemiaSevere anemia + perianal painSevere anemiaSevere anemiaSevere anemiaSevere anemia+ sigmoid colon sclerosis-
Hb, g/L
Pre-Op Hb443676633635718752787278767863 (35-87)
Post-Op 3 mo85-85--4587-------75 (45-87)
Post-Op 6 m----94--77--108118--99 (77-118)
Post-Op 9 mo---102-75120----117122-107 (75-120)
Post-Op 1 yr---100113--123114114---105111 (100-123)
Post-Op 2 yr--118102-111135130114-110-117-117 (102-135)
Post-Op transfusionNoYesNoNoNoyesNoyesNoNoNoNoNoNo
Stoma closureYesNoYesYesYesYesYesYesYesYesYesYesYesYes13 (Yes, 93%)
Stoma complicationsHernia-----Prolapse-Obstruction-----3 (Yes, 21%)
Pre-Op bleeding score333333322323333 (2-3)1
Bleeding score at stoma reversal--1111-100-0111 (0-1)1
Treatment after stoma-----APC 1Formalin 1APC 1--APC 1---
Table 3 Magnetic resonance imaging findings at post-colostomy and at reversal compared in 5 patients with chronic radiation proctopathy
Variable, mmPre-colostomy, mean ± SDAt reversal, mean ± SDP value, paired t-test
Thickness of rectal wall10.76 ± 4.298.91 ± 1.610.047
Width of presacral space15.57 ± 8.8615.84 ± 4.110.328
Thickness of left levator ani2.81 ± 1.073.18 ± 1.390.341
Thickness of right levator ani3.42 ± 1.263.45 ± 1.660.944
Thickness of left gluteus maximus muscle31.36 ± 3.8032.21 ± 9.00.769
Thickness of right gluteus maximus muscle29.89 ± 4.1932.15 ± 11.950.693
Thickness of left obturator internus15.16 ± 1.9717.89 ± 1.770.160
Thickness of right obturator internus13.79 ± 4.9014.36 ± 5.500.060
Thickness of distal part of sigmoid colon4.50 ± 0.735.08 ± 1.170.503
Table 4 Rectal manometry assessment of anorectal functions before stoma reversals
PatientTensity of anorectal ringFunction of contractionDiagnosisSensitivity of rectal mucosaRectal volumeRepression of anorectum reflexAnal relaxation when simulating defecation
1IncreaseGoodInternal sphincter spasmIncreaseNormalNormalGood
4IncreaseGood-NormalDecreaseNormalGood
6DecreaseDecreaseDecreased sphincter functionIncreaseDecreaseNormalGood
9NormalDecreaseDecreased sphincter functionIncreaseDecreaseAbnormalGood
12NormalDecrease-IncreaseDecreaseGood
14NormalGood-IncreaseDecreaseAbnormalGood
Table 5 Quality of life in the colostomy group and conservative group of chronic radiation proctopathy patients based on the EORTC QLQ-C30 scale
QLQ-C30 scaleReference: Normal German populationColostomy group, n = 14, mean ± SD
Conservative group, n = 25, mean ± SD
Pretreat-mentFollow-upΔ(FU)-Pre2Signifi-cance1Pretreat-mentFollow-upΔ(FU)-PreSignifi-cance1
Global health63.223.1 ± 15.163.1 ± 18.340< 0.00147.1 ± 21.562.3 ± 25.015.20.033
Physical function82.650.7 ± 17.887.1 ± 13.736.4< 0.00178.0 ± 22.778.6 ± 26.10.60.856
Role function7534.3 ± 23.989.3 ± 20.555< 0.00177.5 ± 24.977.5 ± 29.100.775
Emotional function62.246.3 ± 27.485.7 ± 14.939.4< 0.00175.7 ± 17.680.8 ± 23.85.10.384
Cognition function81.392.6 ± 12.795.2 ± 9.82.61.094.2 ± 15.695.7 ± 9.01.50.798
Social function78.443.5 ± 28.979.8 ± 18.036.3< 0.00191.3 ± 20.689.1 ± 21.1-2.20.916
Fatigue34.172.8 ± 12.910.3 ± 18.5-62.5< 0.00126.6 ± 24.123.2 ± 27.2-3.40.695
Nausea/ vomiting5.74.6 ± 15.50 ± 0-4.6-5.1 ± 15.46.5 ± 16.51.40.655
Pain33.144.4 ± 28.39.5 ± 15.1-34.9< 0.00114.5 ± 21.511.6 ± 18.4-2.90.481
Dyspnea18.842.6 ± 31.04.8 ± 11.7-37.8< 0.00114.5 ± 19.78.7 ± 18.0-5.80.210
Insomnia38.548.1 ± 35.511.9 ± 20.3-36.2< 0.00121.7 ± 21.626.1 ± 31.74.40.287
Appetite loss9.422.2 ± 27.20 ± 0-22.2-10.1 ± 25.58.7 ± 18.0-1.40.785
Constipation9.19.3 ± 14.99.5 ± 15.1-0.21.08.7 ± 20.67.2 ± 22.4-1.50.414
Diarrhea9.233.3 ± 33.39.5 ± 26.5-23.8< 0.00111.6 ± 23.82.9 ± 9.6-8.70.078
Financial difficulties17.159.3 ± 26.223.8 ± 31.9-35.5< 0.00126.1 ± 31.724.6 ± 30.5-1.50.595