If you are heading into CRS and HIPEC for appendix cancer, there is a conversation worth having with your surgical team before the day of surgery, and it is the one most patients tell us they wish they had pushed harder for: the stoma conversation.
A retrospective study published this spring in Medical Research Archives looked at 110 patients who underwent CRS and HIPEC for peritoneal disease from appendiceal and colorectal cancers between 2009 and 2018. The authors asked a question that does not get enough airtime in pre-op appointments. Who ends up with a stoma, what predicts it, and what actually happens afterward?
Here is what they found, and what it means for you.
Most patients in this study had a stoma created
Of the 110 patients, 78 (about 71 percent) had a stoma during their cytoreductive surgery. Most were ileostomies, with a smaller share of colostomies, and roughly 16 percent were specifically diverting ileostomies meant to protect a downstream anastomosis.
Stomas were more likely in patients whose tumors were in the rectum, who had a BMI under 30, who had low albumin going into surgery, or who had received neoadjuvant chemotherapy. They were also more likely when the surgery itself was bigger: a peritoneal cancer index of 10 or higher, more extensive cytoreduction, multiple small bowel resections, multivisceral resections, and more blood loss and transfusion all tracked with stoma formation.
In other words, the stoma is rarely a surprise to the surgeon. The factors that predict it are mostly visible before you go to sleep.
Reversal was less common than many patients expect
This is the part of the paper worth slowing down for. The authors report that only 8 of the patients who could be assessed for closure had their stomas reversed, and they explicitly flag this finding in their conclusions as a reason for stronger preoperative counseling. When reversal did happen, it occurred at an average of about 5.3 months after the original surgery, and the closure operations themselves were relatively safe, with a 4.5 percent complication rate.
The takeaway is not that reversal is impossible. It is that a meaningful number of people who go into CRS and HIPEC believing their stoma will be temporary end up living with it permanently, and that possibility deserves to be on the table before surgery, not after.
Recoveries were harder for patients with stomas
Patients with stomas in this cohort had more surgical site infections, more severe complications by Clavien-Dindo grade, longer hospital stays, higher reoperation rates, and higher mortality than patients without stomas. Overall complication rates were similar between the two groups, around 53 to 56 percent, but the severity skewed worse in the stoma group.
The authors are careful, and so should we be, in interpreting this. Patients who get stomas in this setting are usually the patients with more disease, longer operations, and more organs involved. The stoma is a marker of surgical complexity, not the cause of the harder recovery. Still, knowing this pattern exists helps you and your caregivers plan for what the post-op weeks might actually look like.
Questions worth asking your surgeon
Based on what this study highlights, a few questions are worth raising at your pre-op visit.
| What is the realistic chance, given my imaging and labs, that I will leave the OR with a stoma? |
| What features of my case push that probability up or down? |
| If a stoma is created, what is the plan for evaluating reversal, and what would have to be true at that point for reversal to be on the table? |
| If reversal is not possible, what does long-term life with this stoma look like in your practice? |
These are not adversarial questions. Good surgical teams welcome them, because patients who understand what is coming recover better and advocate for themselves more effectively.
A few honest caveats
This study mixed appendiceal and colorectal patients together rather than reporting them separately, which matters because the natural history and surgical patterns of these cancers are not identical. It was retrospective, single-center, and conducted at a high-volume quaternary referral hospital, which the authors note may make complications easier to manage there than at smaller centers. The findings are directionally useful, but they are not the last word.
What they do tell us, clearly, is that stomas in CRS and HIPEC are common, that permanence is more frequent than most patients expect, and that the conversation about all of this belongs in the pre-op visit.
Bottom line
Stomas are a common part of CRS and HIPEC for peritoneal disease. Reversal is not guaranteed. Knowing your individual risk, and what would have to be true for reversal to happen, is part of being a prepared patient.
Source: Moreno Djadou T. Stomas in Cytoreductive Surgery and Hyperthermic Intraoperative Peritoneal Chemotherapy for Colorectal and Appendiceal Tumors: Risk Factors and Outcomes. https://esmed.org/MRA/mra/article/view/7481Medical Research Archives, Vol. 14, No. 4, April 2026.
Read this next:Life After CRS/HIPEC Surgery & GLP-1 Update That Looks Promising
Leave a Reply