Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?,Surgical Endoscopy

当前位置： X-MOL 学术 › Surg. Endosc. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-10-04 , DOI: 10.1007/s00464-022-09580-5
Natasha G Caminsky _{1,

2} , Jeongyoon Moon _{1,

2} , Nancy Morin ₂ , Karim Alavi ₃ , Rebecca C Auer ₄ , Liliana G Bordeianou ₅ , Sami A Chadi ₆ , Sébastien Drolet ₇ , Amandeep Ghuman ₈ , Alexander Sender Liberman ₁ , Tony MacLean ₉ , Ian M Paquette ₁₀ , Jason Park ₁₁ , Sunil Patel ₁₂ , Scott R Steele ₁₃ , Patricia Sylla ₁₄ , Steven D Wexner ₁₅ , Carol-Ann Vasilevsky ₂ , Fateme Rajabiyazdi ₁₆ , Marylise Boutros _{1,

2}

Affiliation

Department of Surgery, Division of General Surgery, McGill University Health Centre, Montreal, QC, Canada.
Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada.
Division of Colon and Rectal Surgery, University of Massachusetts, Boston, MA, USA.
Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Department of Surgery, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA, USA.
Minimally Invasive and Colorectal Surgery, University Health Network and Princess Margaret Hospital, Toronto, ON, Canada.
Department of Surgery, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec City, QC, Canada.
Division of Colon and Rectal Surgery, St. Paul's Hospital, Vancouver, BC, Canada.
Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Department of Surgery, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada.
Department of Surgery, Queens University, Kingston, ON, Canada.
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada.

Background

Early ileostomy closure (EIC), \(\le\) 2 weeks from creation, is a relatively new practice. Multiple studies have demonstrated that this approach is safe, feasible, and cost-effective. Despite the demonstrated benefits, this is neither routine practice, nor has it been studied, in North America. This study aimed to assess patient and surgeon perspectives about EIC.

Methods

A mixed-methods, cross-sectional study of patients and surgeons was performed. Rectal cancer survivors from a single institution who underwent restorative proctectomy with diverting loop ileostomy and subsequent closure within the last 5 years were contacted. North American surgeons with high rectal cancer volumes (> 20 cases/year) were included. Surveys (patients) and semi-structured interviews (surgeons) were conducted. Analysis employed descriptive statistics and thematic analysis, respectively.

Results

Forty-eight patients were surveyed (mean age 65.1 ± 11.8 years; 54.2% male). Stoma closure occurred after a median of 7.7 months (IQR 4.8–10.9) and 50.0% (24) found it “difficult” or “very difficult” to live with their stoma. Patients considered improvement in quality of life and quicker return to normal function the most important advantages of EIC, whereas the idea of two operations in two weeks being too taxing on the body was deemed the biggest disadvantage. Most patients (35, 72.9%) would have opted for EIC. Surgeon interviews (15) revealed 4 overarching themes: (1) there are many benefits to EIC; (2) specific patient characteristics would make EIC an appropriate option; (3) many barriers to implementing EIC exist; and (4) many logistical hurdles need to be addressed for successful implementation. Most surgeons (12, 80.0%) would “definitely want to participate” in a North American randomized-controlled trial (RCT) on EIC for rectal cancer patients.

Conclusions

Implementing EIC poses many logistical challenges. Both patients and surgeons are interested in further exploring EIC and believe it warrants a North American RCT to motivate a change in practice.

Graphical abstract

中文翻译：

患者和外科医生对直肠癌恢复性直肠切除术后早期回肠造口关闭的偏好：我们为什么不这样做？

背景

早期回肠造口术关闭 (EIC)，创建后 2 周，是一种相对较新的做法。多项研究表明，这种方法安全、可行且具有成本效益。尽管有明显的好处，但这在北美既不是常规做法，也没有被研究过。本研究旨在评估患者和外科医生对 EIC 的看法。

方法

对患者和外科医生进行了混合方法横断面研究。联系了来自单一机构的直肠癌幸存者，这些患者在过去 5 年内接受了恢复性直肠切除术和回肠环回肠造口术并随后进行了闭合术。包括直肠癌体积大（> 20 例/年）的北美外科医生。进行了调查（患者）和半结构式访谈（外科医生）。分析分别采用描述性统计和主题分析。

结果

调查了 48 名患者（平均年龄 65.1 ± 11.8 岁；54.2% 为男性）。造口关闭发生在中位 7.7 个月 (IQR 4.8–10.9) 之后，50.0% (24) 发现带着造口生活“困难”或“非常困难”。患者认为改善生活质量和更快恢复正常功能是 EIC 最重要的优势，而两周内进行两次手术的想法对身体来说太费力了被认为是最大的劣势。大多数患者 (35, 72.9%) 会选择 EIC。外科医生访谈 (15) 揭示了 4 个总体主题：(1) EIC 有很多好处；(2) 特定的患者特征将使 EIC 成为合适的选择；(3)实施EIC存在诸多障碍；(4) 要成功实施，需要解决许多后勤障碍。大多数外科医生 (12, 80.0%) 会“绝对想参加”一项针对直肠癌患者的 EIC 的北美随机对照试验 (RCT)。