EP147 - The Fate of the “Temporary” Stoma in Anal Squamous Cell Carcinoma

Saturday, May 9, 2026

3:53 PM - 3:58 PM ET

ePoster Presenter(s)

Kayvan Barekatain, MD (he/him/his)

Resident Physician
Case Western Reserve University Hospitals
University Hospitals, Cleveland Medical Center
Cleveland, OH, United States

Disclosure information not submitted.

Author(s)

Emily F. Simon, MD (she/her/hers)

General Surgery Resident
University Hospitals Cleveland Medical Center, Department of Surgery
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
ES

Emily Steinhagen, MD, FACS, FASCRS

Associate Professor of Surgery
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
KB

Katherine Bingmer, MD

Surgical Oncologist
Piedmont Hospital
Atlanta, Georgia, United States

Disclosure information not submitted.
Kristen Westfall, MD, MPH (she/her/hers)

Assistant Professor of Surgery
University Hospitals/Cleveland Medical Center
Case Western Reserve University
Cleveland, OH, United States

Disclosure information not submitted.
MC

Madison Conces, MD

Assistant Professor
Case Comprehensive Cancer Center/Seidman Cancer Center of University Hospitals
Cleveland, Ohio, United States

Disclosure information not submitted.
JH

Jay Han, n/a

Medical Student
Case Western Reserve University School of Medicine
Cleveland, Ohio, United States

Disclosure information not submitted.
JG

Jenny Gong, MD

Resident Physician
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure information not submitted.
SK

Saher-Zahra Khan, MD

General Surgery Resident
University Hospitals Cleveland Medical Center
South Euclid, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Marnie Abeshouse, MD

Colon and Rectal Surgery Fellow
University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MC

Meagan Costedio, MD (she/her/hers)

Medical Director of Colorectal Surgery
Ahuja Medical Center of University Hospitals
Case Western University
Beachwood, OH, United States

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This individual has no financial relationships with ineligible companies.

Senior Author(s)

Ronald Charles, MD (he/him/his)

Assistant Professor of Surgery
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, OH, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Emily F. Simon, MD: This individual has no financial relationships with ineligible companies.

Emily Steinhagen, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Saher-Zahra Khan, MD: This individual has no financial relationships with ineligible companies.

Marnie Abeshouse, MD: This individual has no financial relationships with ineligible companies.

Meagan Costedio, MD: This individual has no financial relationships with ineligible companies.

Purpose/Background: Diverting ostomies are indicated in select patients with anal squamous cell carcinoma (aSCC) to relieve obstruction, manage fistulae, palliate pain, and manage complications from chemoradiation. However, the incidence of this practice is not well-reported in the literature, and long-term outcomes with regards to cancer and intestinal continuity remain unknown.

Methods/Interventions: A retrospective review of patients with aSCC treated at a tertiary center between 2000 and 2018 was performed. Demographics, tumor characteristics, indications for diversion, and outcomes were compared between diverted and non-diverted patients using descriptive and inferential statistics. Categorical variables were analyzed using chi-square or Fisher’s exact tests, and continuous variables with t-tests or Wilcoxon rank-sum tests, as appropriate. Overall survival (OS) was defined as the time from diagnosis to last follow-up or death and compared between groups using Kaplan–Meier estimates and log-rank test.

Results/Outcomes: Among 136 patients with aSCC, the median age was 57 years (SD: 12.1), 67% were female, and the median BMI was 27.2 kg/m2 (SD: 6.4). Most were white (76%) and presented with locally advanced disease (Tis: 0.7%, T1: 13.2%, T2: 31.6%, T3: 23.5%, T4: 17.6%, Tunknown: 13.2%). Corresponding stages were Tis = 0.7%, stage I=9.6%, stage II=34.6%, stage III=40.4%, stage IV=1.5%, unknown= 13.2%.

Nineteen patients (14%) required diversion for pain (n=8), fistula (n=7), or obstruction (n=4). Of these diversions ten occurred prior to chemoradiation, four during, and five after. Compared with non-diverted patients, there were no significant differences in age (p=0.13), gender (p=0.37) or BMI (p=0.52). Diverted patients trended toward more advanced disease at presentation (58% T3-T4 vs 38% in non-diverted group; p=0.11) but overall stage did not differ (p=0.64). Survival analysis demonstrated reduced OS among diverted patients (5-year survival 50% vs 75% for non-diverted; log-rank p=0.028).

Among diverted patients, 9 of 19 (47.4%) achieved complete clinical response to chemoradiation. Of the 10 without a complete response, 3 underwent abdominopelvic resection and 2 underwent pelvic exenteration (median 311 days from diversion to surgery); 4 died of disease progression and 1 was lost to follow-up. Only two patients (10.5%) underwent stoma reversal, both of whom were originally diverted for pain and were complete responders.

Conclusion/Discussion: In this cohort, fecal diversion to treat symptoms related to aSCC was infrequent, but rarely truly temporary. Most patients either died of disease or required further surgery precluding reversal. Moreover, the higher-than-expected rate of failure of chemoradiation in this cohort of patients suggests that symptom severity is potentially associated with worse outcomes. Diverted patients had significantly decreased OS, underscoring that need for diversion may reflect more aggressive tumor biology. These findings underscore the need for high quality data to guide shared decision making in this patient population.