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04.10.2022 | 2021 SAGES Oral

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

verfasst von: Natasha G. Caminsky, Jeongyoon Moon, Nancy Morin, Karim Alavi, Rebecca C. Auer, Liliana G. Bordeianou, Sami A. Chadi, Sébastien Drolet, Amandeep Ghuman, Alexander Sender Liberman, Tony MacLean, Ian M. Paquette, Jason Park, Sunil Patel, Scott R. Steele, Patricia Sylla, Steven D. Wexner, Carol-Ann Vasilevsky, Fateme Rajabiyazdi, Marylise Boutros

Erschienen in: Surgical Endoscopy | Ausgabe 1/2023

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Abstract

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

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Titel: Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?
verfasst von: Natasha G. Caminsky
Jeongyoon Moon
Nancy Morin
Karim Alavi
Rebecca C. Auer
Liliana G. Bordeianou
Sami A. Chadi
Sébastien Drolet
Amandeep Ghuman
Alexander Sender Liberman
Tony MacLean
Ian M. Paquette
Jason Park
Sunil Patel
Scott R. Steele
Patricia Sylla
Steven D. Wexner
Carol-Ann Vasilevsky
Fateme Rajabiyazdi
Marylise Boutros
Publikationsdatum: 04.10.2022
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 1/2023
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-022-09580-5

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