Colostomy Procedure for Low Rectal Cancer

Definitive Surgical Management

The National Comprehensive Cancer Network recommends abdominoperineal resection (APR) with total mesorectal excision (TME) for low rectal cancer, which necessitates creation of a permanent end sigmoid colostomy 1, 2
APR with permanent end colostomy is indicated when the tumor directly involves the anal sphincter or levator muscles, or when a margin-negative resection would result in loss of anal sphincter function and incontinence 1, 2
The British Journal of Cancer guidelines suggest that APR with permanent end colostomy is also indicated when the tumor is located in the lower third of the rectum and sphincter preservation is not technically feasible 3, 4

The World Journal of Emergency Surgery recommends creating a transverse loop colostomy rather than performing emergency resection for low rectal cancer obstruction, allowing for proper staging workup and timely initiation of neoadjuvant chemoradiotherapy 5, 6
Transverse loop colostomy is preferred over sigmoid colostomy due to its ease of creation, avoidance of risk of damage to the marginal arcade, and preservation of the left abdominal region for potential future permanent end colostomy 5, 6

The National Comprehensive Cancer Network reports that patients undergoing APR experience worse body image, worse micturition symptoms, and less sexual enjoyment compared to those with sphincter-sparing surgery, although long-term quality of life appears fairly comparable 1
The British Journal of Cancer guidelines state that the safe distal margin for rectal resection must be ≥2 cm from the lower tumor edge, and a minimum of 6-8 lymph nodes should be examined 3, 4