Patients eligible for this operation (not of advanced age, psychologically stable and without metastatic disease) should be strongly motivated to avoid the abdominal colostomy and should be correctly and fully informed about the expected results. They should be aware that there is a significant risk of infections and that functional results are not always good, a reasonably good outcome being expected only in about 50% of cases in the long term , although the success rate may depend on the surgeon's experience and the number of patients operated on in each centre. But, most importantly, they should understand that a perineal colostomy is just a colostomy and that they will never experience normal defecation in the same way as they did before surgery. Another major point for correct information is that a relevant proportion of these patients have defecatory difficulty, often requiring enemas and prolonged time on the toilet to empty the neorectum.
Finally, it is ethically correct to propose this surgical option not before the cancer operation, but only after an adequate follow-up period, when the risk of cancer recurrence is lower and if the patient's motivation to dispense with an abdominal colostomy is still strong. Patients with advanced rectal cancer or non-curative resection should not therefore be offered this procedure.
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