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

Autor: Caminsky NG; 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., Moon J; 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., Morin N; Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada., Alavi K; Division of Colon and Rectal Surgery, University of Massachusetts, Boston, MA, USA., Auer RC; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada., Bordeianou LG; Department of Surgery, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA, USA., Chadi SA; Minimally Invasive and Colorectal Surgery, University Health Network and Princess Margaret Hospital, Toronto, ON, Canada., Drolet S; Department of Surgery, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec City, QC, Canada., Ghuman A; Division of Colon and Rectal Surgery, St. Paul's Hospital, Vancouver, BC, Canada., Liberman AS; Department of Surgery, Division of General Surgery, McGill University Health Centre, Montreal, QC, Canada., MacLean T; Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada., Paquette IM; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA., Park J; Department of Surgery, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada., Patel S; Department of Surgery, Queens University, Kingston, ON, Canada., Steele SR; Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA., Sylla P; Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Wexner SD; Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA., Vasilevsky CA; Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada., Rajabiyazdi F; Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada., Boutros M; Department of Surgery, Division of General Surgery, McGill University Health Centre, Montreal, QC, Canada. mboutros@jgh.mcgill.ca.; Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada. mboutros@jgh.mcgill.ca.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Jan; Vol. 37 (1), pp. 669-682. Date of Electronic Publication: 2022 Oct 04.
DOI: 10.1007/s00464-022-09580-5
Abstrakt: Background: Early ileostomy closure (EIC), ≤ 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.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: