Incidence, Risk Factors, and Prediction Model of Parastomal Hernia After Abdominoperineal Resection for Rectal Cancer

作者：Jiyun Li, Jichuan Quan, Zixing Zhu, Dedi Jiang, Zhixun Zhao, Mingguang Zhang, Jianjun Bi, Qiang Feng, Zheng Wang, Haitao Zhou, Wei Pei, Qian Liu, Zhaoxu Zheng, Minjie Wang, Jianwei Liang · 发表于：World Journal of Surgery · 年份：2025 · DOI：10.1002/wjs.70071 · 被引用次数：5 · 研究领域：Stoma care and complications、Colorectal Cancer Surgical Treatments、Surgical site infection prevention

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: (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.