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Updated: Sep 9, 2025
Author Spotlight: Advancing Early Detection and Treatment of Gastrointestinal Tumors
Published on: February 16, 2024
Incidence, Risk Factors, and Prediction Model of Parastomal Hernia After Abdominoperineal Resection for Rectal Cancer
Jiyun Li1, Jichuan Quan1, Zixing Zhu1
1Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Background:
Parastomal hernia (PSH) is a frequent complication of abdominoperineal resection (APR), yet large-scale studies characterizing its long-term incidence and tools for individualized risk stratification remain lacking. To determine the long-term incidence, independent risk factors, and develop a clinical prediction model for PSH after APR in rectal cancer patients.
Methods:
We conducted a retrospective cohort study of 836 patients with rectal adenocarcinoma who underwent APR and permanent end colostomy at a high-volume tertiary center (2014-2018). PSH was diagnosed according to the European Hernia Society criteria. Independent risk factors were identified using Cox regression, and a nomogram was developed to predict 1- to 5-year PSH probabilities. Model discrimination was assessed using time-dependent AUC.
Results:
During a median follow-up period of 85 months, 207 patients (24.8%) developed PSH, with a cumulative incidence of 26.2% at 5 years. Independent risk factors included female sex (HR = 2.28, 95% CI: 1.73-3.01), age ≥ 60 years (HR = 5.17, 95% CI: 3.72-7.18), BMI ≥ 24 kg/m2 (HR = 2.10, 95% CI: 1.57-2.80), and transperitoneal stoma route (HR = 4.11, 95% CI: 2.63-6.41; all P < 0.001). The nomogram demonstrated strong discrimination with 1-, 2-, 3-, 4-, and 5-year AUCs of 0.65, 0.70, 0.76, 0.80, and 0.83, respectively.
Conclusion:
This study provides evidence on PSH incidence and risk factors, introducing a nomogram for personalized risk stratification. The nomogram allows clinicians to identify high-risk patients and tailor preventive strategies, such as extraperitoneal stoma creation or prophylactic mesh placement, to reduce PSH burden.
