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

ABSTRACT 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/m 2 (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.