Fateme Rajabiyazdi1, Marylise Boutros2,3, Natasha G Caminsky4,5, Jeongyoon Moon4,5, Nancy Morin5, Karim Alavi6, Rebecca C Auer7, Liliana G Bordeianou8, Sami A Chadi9, Sébastien Drolet10, Amandeep Ghuman11, Alexander Sender Liberman4, Tony MacLean12, Ian M Paquette13, Jason Park14, Sunil Patel15, Scott R Steele16, Patricia Sylla17, Steven D Wexner18, Carol-Ann Vasilevsky5. 1. Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada. 2. Department of Surgery, Division of General Surgery, McGill University Health Centre, Montreal, QC, Canada. mboutros@jgh.mcgill.ca. 3. Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada. mboutros@jgh.mcgill.ca. 4. Department of Surgery, Division of General Surgery, McGill University Health Centre, Montreal, QC, Canada. 5. Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada. 6. Division of Colon and Rectal Surgery, University of Massachusetts, Boston, MA, USA. 7. Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada. 8. Department of Surgery, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA, USA. 9. Minimally Invasive and Colorectal Surgery, University Health Network and Princess Margaret Hospital, Toronto, ON, Canada. 10. Department of Surgery, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec City, QC, Canada. 11. Division of Colon and Rectal Surgery, St. Paul's Hospital, Vancouver, BC, Canada. 12. Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada. 13. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. 14. Department of Surgery, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada. 15. Department of Surgery, Queens University, Kingston, ON, Canada. 16. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA. 17. Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 18. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Abstract
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.
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.
Authors: Evangelos Messaris; Rishabh Sehgal; Susan Deiling; Walter A Koltun; David Stewart; Kevin McKenna; Lisa S Poritz Journal: Dis Colon Rectum Date: 2012-02 Impact factor: 4.585
Authors: G F Giannakopoulos; A A F A Veenhof; D L van der Peet; C Sietses; W J H J Meijerink; M A Cuesta Journal: Colorectal Dis Date: 2008-10-01 Impact factor: 3.788