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Fazio R, Audisio A, Daprà V, Conti C, Benhima N, Abbassi FZ, Assaf I, Hendlisz A, Sclafani F. Non-operative management after immune checkpoint inhibitors for early-stage, dMMR/MSI-H gastrointestinal cancers. Cancer Treat Rev 2024; 128:102752. [PMID: 38772170 DOI: 10.1016/j.ctrv.2024.102752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/23/2024]
Abstract
Surgery is a standard treatment for early-stage gastrointestinal cancers, often preceded by neoadjuvant chemo(radio)therapy or followed by adjuvant therapy. While leading to cure in a proportion of patients, it has some drawbacks such as intra/post-operative complications, mutilation and life-long functional sequelae. Further to the unprecedented efficacy data from studies of immune checkpoint inhibitors for advanced mismatch repair deficient/microsatellite instable (dMMR/MSI-H) tumours, a strong interest has recently emerged for the investigation of such agents in the neoadjuvant setting. Although limited by the exploratory design and small sample size, trials of neoadjuvant immune checkpoint inhibitors for early-stage dMMR/MSI-H gastrointestinal cancers have consistently reported complete response rates ranging from 70 % to 100 %. As a result, the question has arisen as to whether surgery is still needed or organ-preserving strategies should be offered to this especially immuno-sensitive population. In this article, we discuss the available evidence for neoadjuvant immune checkpoint inhibitors in dMMR/MSI-H gastrointestinal cancers and analyse opportunities and challenges to the implementation of non-operative management approaches in this setting.
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Affiliation(s)
- Roberta Fazio
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Alessandro Audisio
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Valentina Daprà
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Chiara Conti
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Nada Benhima
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Fatima-Zahara Abbassi
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Irene Assaf
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Alain Hendlisz
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Francesco Sclafani
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium.
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2
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Aubert M, Buscail E, Duchalais E, Cazelles A, Collard M, Charleux-Muller D, Jeune F, Nuzzo A, Pellegrin A, Theuil L, Toutain A, Trilling B, Siproudhis L, Meurette G, Lefevre JH, Maggiori L, Mege D. Management of adult intestinal stomas: The 2023 French guidelines. J Visc Surg 2024; 161:106-128. [PMID: 38448363 DOI: 10.1016/j.jviscsurg.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIM Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.
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Affiliation(s)
- Mathilde Aubert
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France
| | - Etienne Buscail
- Digestive Surgery Department, hôpital Rangueil, Toulouse, France
| | | | - Antoine Cazelles
- Digestive Surgery Department, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Maxime Collard
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | | | - Florence Jeune
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Alexandre Nuzzo
- Digestive Surgery Department, hôpital Beaujon, AP-HP, Paris, France
| | | | | | - Amandine Toutain
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Jérémie H Lefevre
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France.
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Wen ZL, Bai L, Zhou X. Novel stent-assisted ileal bypass is applied to avoid protective stoma and prevent anastomotic leakage for rectal cancer. ANZ J Surg 2024; 94:418-423. [PMID: 37984380 DOI: 10.1111/ans.18781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE This study aimed to investigate the safety and feasibility of a novel stent-assisted ileal bypass for rectal cancer patients who received sphincter-preserving surgery. METHODS Patients who were diagnosed with rectal cancer and received sphincter-preserving surgery plus a novel stent-assisted ileal bypass were respectively included from January 2022 to January 2023. Biofragmentable ileal stent with diaphragm sheet in the cavity was placed in the terminal ileum using absorbable sutures after anastomosis. At the proximal end of the stent, an intestinal diversion tube was placed in the prefabricated purse-string, through which faeces were drained. The stent completely disintegrated in the body after 3-4 weeks, which protected the anastomosis after surgery and avoided protective stoma. Clinical characteristics and surgical outcomes were collected. RESULTS Eleven patients who successfully received surgery were included. There were seven (63.6%) males and four (36.4%) females. The tumour size was 3.2 ± 1.7 cm and the lower verge of tumour to anal verge was 6.8 ± 1.3 cm. As for surgical outcomes, operation time was 216.4 ± 54.1 min, blood loss was 43.6 ± 64.6 mL, time to first flatus via intestinal diversion tube was 3.2 ± 1.1 days, time to discharge stent was 22.8 ± 3.0 days, and postoperative hospital stay was 21.0 ± 5.4 days. Two patients suffered from postoperative complications including pneumonia and incision infection. CONCLUSION This novel stent-assisted ileal bypass is safe and feasible, it provides a new choice for rectal cancer patients to avoid protective stoma and secondary surgery.
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Affiliation(s)
- Ze-Lin Wen
- Department of Gastrointestinal Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Lian Bai
- Department of Gastrointestinal Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiong Zhou
- Department of Gastrointestinal Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Ayik C, Bişgin T, Cenan D, Manoğlu B, Özden D, Sökmen S. Risk factors for early ostomy complications in emergency and elective colorectal surgery: A single-center retrospective cohort study. Scand J Surg 2024; 113:50-59. [PMID: 38041524 DOI: 10.1177/14574969231190291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND AIMS The clinical significance of early ostomy complications has been emphasized worldwide, and the current evidence concerning the impact of emergency or elective surgery on ostomy complications is limited. This study aimed to investigate the effect of elective and emergency colorectal surgery on early ostomy complications and the risk factors associated with specific complications. METHODS A mandatory colorectal recording system for consecutive ostomy patients between 2012 and 2020 was reviewed retrospectively. Patient socio-demographics, ostomy-related variables, and early period ostomy complications were retrieved from the patient records. The chi-square test, t-test, analysis of variance (ANOVA), and logistic regression were used to analyze the data. RESULTS The study cohort included 872 patients. At least one or more complications developed in 573 (65.7%) patients, 356 (63.6%) in the emergency group, and 217 (69.6%) in the elective group. When comparing emergency surgery to elective surgery, necrosis (7.4% versus 3.4%, p = 0.009), mucocutaneous separation (37.2% versus 27.1%, p = 0.002), and bleeding (6.1% versus 2.1%, p = 0.003) were more prevalent. Peristomal irritant contact dermatitis (PICD) (37.3% versus 26%, p < 0.001) was more common in elective surgery. Risk factors for PICD were comorbidity (p = 0.003), malignant disease (p = 0.047), and loop ostomy (p < 0.001) in elective surgery; female sex (p = 0.025), neo-adjuvant therapy (p = 0.024), and ileostomy (p = 0.006) in emergency surgery. The height of the ostomy (less than 10 mm) was a modifiable risk factor for mucocutaneous separation in both elective surgery (p < 0.001) and emergency surgery (p = 0.045). CONCLUSION Early ostomy complications were more likely to occur after emergency colorectal surgery than in an elective setting. Patient- and ostomy-related risk factors for complications differed between elective and emergency surgeries.
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Affiliation(s)
- Cahide Ayik
- Assistant Professor, Faculty of Nursing, Dokuz Eylul University, Izmir 35330, Turkey
| | - Tayfun Bişgin
- Department of General Surgery, Dokuz Eylul University, Turkey
| | - Deniz Cenan
- Dokuz Eylul University Hospital, Izmir, Turkey
| | - Berk Manoğlu
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Selman Sökmen
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
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5
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van der Storm SL, Consten ECJ, Govaert MJPM, Tuynman JB, Oosterling SJ, Grotenhuis BA, Smits AB, Marsman HA, van Rossem CC, van Duyn EB, de Nes LCF, Verdaasdonk E, de Vries Reilingh TS, Vening W, Bemelman WA, Schijven MP. Better stoma care using the Stoma App: does it help? A first randomized double-blind clinical trial on the effect of mobile healthcare on quality of life in stoma patients. Surg Endosc 2024; 38:1442-1453. [PMID: 38191813 PMCID: PMC10881728 DOI: 10.1007/s00464-023-10593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/11/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Receiving a stoma significantly impacts patients' quality of life. Coping with this new situation can be difficult, which may result in a variety of physical and psychosocial problems. It is essential to provide adequate guidance to help patients cope with their stoma, as this positively influences self-efficacy in return. Higher self-efficacy reduces psychosocial problems increasing patient's quality of life. This study investigates whether a new mobile application, the Stoma App, improves quality of life. And if personalized guidance, timed support, and peer contact offered as an in-app surplus makes a difference. METHODS A double-blind, randomized controlled trial was conducted between March 2021 and April 2023. Patients aged > 18 years undergoing ileostomy or colostomy surgery, in possession of a compatible smartphone were included. The intervention group received the full version of the app containing personalized and time guidance, peer support, and generic (non-personalized) stoma-related information. The control group received a restricted version with only generic information. Primary outcome was stoma quality of life. Secondary outcomes included psychological adaption, complications, re-admittance, reoperations, and length of hospital stay. RESULTS The intervention version of the app was used by 96 patients and the control version by 112 patients. After correction for confounding, the intervention group reported a significant 3.1-point improvement in stoma-related quality of life one month postoperatively (p = 0.038). On secondary outcomes, no significant improvements could be retrieved of the intervention group. CONCLUSION The Stoma App improves the quality of life of stoma patients. Peer support and personalized guidance are of significant importance in building self-efficacy. It is to be recommended to implement Stoma app-freely available software qualifying as a medical device-in standard stoma care pathways for the benefits of both patients and healthcare providers.
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Affiliation(s)
- Sebastiaan L van der Storm
- Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands.
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Public Health, Digital Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Esther C J Consten
- Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | - Anke B Smits
- Surgery, Antonius Ziekenhuis, Nieuwengein, The Netherlands
| | | | | | | | | | | | | | - Wouter Vening
- Surgery, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Willem A Bemelman
- Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands.
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Public Health, Digital Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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6
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Brady RRW, Scott J, Grieveson S, Aibibula M, Cawson M, Marks T, Page J, Artignan A, Boisen EB. Complications and Healthcare Costs Associated With the First Year Following Colostomy and Ileostomy Formation: A Retrospective Study. J Wound Ostomy Continence Nurs 2023; 50:475-483. [PMID: 37966075 DOI: 10.1097/won.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical and economic outcomes during the first year following ostomy formation. DESIGN Single-center retrospective audit. SUBJECTS AND SETTING The sample comprised 200 patients who underwent surgery leading to ileostomy or colostomy at a large English National Health Service (NHS) Trust. METHODS Clinical complications, medicine prescriptions, and interactions with healthcare services were reported over 12 months postsurgery, and interactions with the NHS were matched to the closest NHS unit cost to determine mean patient cost. RESULTS The most common ostomy-related surgical site complications were high output (35.0%; n = 70), followed by moderate/severe peristomal skin complications (24.5%; n = 49) and bleeding (23.5%; n = 47). Ostomy management-related complications included general difficulties with ostomy management (50.0%; n = 100) and leakage-related mild peristomal skin issues (48.5%; n = 97). Clinical complication rates were highest in the first quarter following ostomy formation, except parastomal hernia, which increased in incidence over time. Ileostomy patients more frequently experienced high output, acute renal failure, and ostomy management-related complications and had increased length of inpatient admission. However, healthcare resource use was high in both groups, with a median of 13 inpatient admission days and 12 outpatient contacts overall within the first year. Mean cost per patient was £20,444.60 (US $26,018.41); 90.5% of these costs were attributed to ostomy-related factors. CONCLUSIONS Patients are likely to experience at least one clinical complication following intestinal ostomy formation and have multiple interactions with the NHS. While a number of complications are more frequent in patients with ileostomies, both groups experienced considerable costs within the first year following surgery associated with ostomy management and recovery.
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Affiliation(s)
- Richard R W Brady
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Julia Scott
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Stephanie Grieveson
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Miriayi Aibibula
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Matthew Cawson
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Tatjana Marks
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Jennifer Page
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Audrey Artignan
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Esben Bo Boisen
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
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7
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Parini D, Bondurri A, Ferrara F, Rizzo G, Pata F, Veltri M, Forni C, Coccolini F, Biffl WL, Sartelli M, Kluger Y, Ansaloni L, Moore E, Catena F, Danelli P. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg 2023; 18:48. [PMID: 37817218 PMCID: PMC10563348 DOI: 10.1186/s13017-023-00516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding. MATERIAL AND METHODS A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011-2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript. CONCLUSION Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.
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Affiliation(s)
- Dario Parini
- General Surgery Department, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Andrea Bondurri
- General Surgery Department, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy.
| | - Francesco Ferrara
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Gianluca Rizzo
- Digestive and Colorectal Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutricional Sciences, University of Calabria, Cosenza, Italy
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
| | - Marco Veltri
- General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
| | - Cristiana Forni
- Nursing and allied profession research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Walt L Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- General Surgery Department, Pavia University Hospital, Pavia, Italy
| | - Ernest Moore
- E. Moore Shock and Trauma Centre, Denver, CO, USA
| | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Piergiorgio Danelli
- General Surgery Department, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milano, Italy
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8
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van der Storm SL, Bemelman WA, van Dieren S, Schijven MP. A personalized app to improve quality of life of patients with a stoma: A protocol for a multicentre randomized controlled trial. Colorectal Dis 2023; 25:2071-2077. [PMID: 37587614 DOI: 10.1111/codi.16694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 08/18/2023]
Abstract
AIM Proper education, guidance and support is crucial before and following creation of a stoma. Patients with a stoma and their close relatives need to adapt to and cope with this new - and sometimes unforeseen - situation, which may result in insecurities and a variety of psychosocial problems. Self-efficacy is associated both with a reduction in psychosocial problems and with improved quality of life. The main objective of this study was to investigate whether self-reported quality of life of patients with a stoma can be enhanced by offering personalized and timed guidance, as well as peer contact, in a patient-centred mobile application. METHOD A multicentre, double-blind, randomized controlled trial will be conducted. Consented adults >18 years of age who will receive an ileostomy or colostomy and possess an eligible smartphone will be included. The intervention group will be given the full version of the application (containing personalized and timed guidance, such as operation-specific information and information on the associated care pathway) to install on their smartphone. In addition, the intervention group has access to a protected peer-support platform within the app. The control group will receive a restricted version of the application that contains only generic (non-personalized) stoma-related information. The primary outcome is quality of life, 3 months postoperatively. Secondary outcomes are Patient Reported Outcome Measures (PROMs), such as psychological adaption, as well as number of complications, re-admission and re-operation rates and the length of hospital stay. RESULTS Patient enrolment began in March 2021. Data collection was not complete when this protocol was submitted. CONCLUSION We hypothesize that patients with a stoma who are supported by the intervention version of the app will report a significantly higher quality of life than patients with a stoma who are supported by the control version of the app (ie, are not offered personalized and timed guidance and information and do not have access to peer support in the app).
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Affiliation(s)
- Sebastiaan L van der Storm
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
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9
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Chan MS, Moore Z, Patton D, McNamara D, O'Connor T, Avsar P. A systematic review of patient risk factors for complications following stoma formation among adults undergoing colorectal surgery. Int J Colorectal Dis 2023; 38:238. [PMID: 37747515 DOI: 10.1007/s00384-023-04523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Stoma formation is a commonly performed procedure both during and following colorectal surgery. When designed correctly, stomas can dramatically improve patients' quality of life, but the reverse may occur when complications arise. Given the significant negative impact of complications following stoma formation, understanding risk factors that may be mitigated pre-operatively is important. METHOD A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in May 2022. Data was extracted and a narrative synthesis undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. The systematic review includes various research designs such as randomised controlled trials (RCT), case-control studies, and observational cohort studies written in English. Reviews, conference papers, opinion papers, and those including participants < 18 years old were excluded. No restrictions on the date of publication and study setting were applied. RESULTS This review included 17 studies, conducted between 2001 and 2020. The study designs were prospective audit, prospective analysis, retrospective analysis, longitudinal analysis and multivariate analysis of self-reported questionaires/surveys. Twenty-two possible risk factors for the development of stoma complications following stoma formation were identified. These include demographical risk factors, underlying medical condition, type of surgery, elective vs emergency surgery, stoma factors, surgical factors, indications for surgery and factors which may impact healing. Furthermore, high BMI, emergency surgery, and stoma type were identified as the most frequently occurring risk factors. CONCLUSION Given the large number of risk factors identified, the implementation of a risk stratification tool may decrease the incidence and prevalence of stoma complication development. This, in turn, would decrease the associated healthcare-related costs, and negative impact on mortality, length of stay and quality of life.
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Affiliation(s)
- Mai Shanley Chan
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Lida Institute, Shanghai, China
- University of Wales, Cardiff, UK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith, QLD, Australia
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Deborah McNamara
- Beaumont Hospital, Dublin, Ireland
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Lida Institute, Shanghai, China
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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10
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Yao S, Lan H, Han Y, Mao C, Yang M, Zhang X, Jin K. From organ preservation to selective surgery: How immunotherapy changes colorectal surgery? Surg Open Sci 2023; 15:44-53. [PMID: 37637243 PMCID: PMC10450522 DOI: 10.1016/j.sopen.2023.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
The emergence of immunotherapy has revolutionized the traditional treatment paradigm of colorectal cancer (CRC). Among them, immune checkpoint blockade has become the first-line treatment for metastatic colorectal cancer (mCRC) and has made significant progress in the treatment of locally advanced colorectal cancer (LACRC). We reviewed a series of clinical trials that have made breakthrough progress. We will emphasize the breakthrough progress in achieving organ preservation in patients with high microsatellite instability or DNA mismatch repair deficiency (MSI-H/dMMR), and based on this, we propose the concept of selective surgery, which includes selectively removing or preserving lymph nodes, with the aim of proving our idea through more research in the future.
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Affiliation(s)
- Shiya Yao
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China
| | - Huanrong Lan
- Department of Surgical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang 310002, China
| | - Yuejun Han
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China
| | - Chunsen Mao
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China
| | - Mengxiang Yang
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China
| | - Xuan Zhang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650106, China
| | - Ketao Jin
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China
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11
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Aljarad F, Gumber A, McLeary AM, Shalli K. Endoscopic transstomal stent insertion: a novel approach for a stenosed stoma in a challenging patient. Ann Coloproctol 2023; 39:357-361. [PMID: 36758565 PMCID: PMC10475800 DOI: 10.3393/ac.2022.00962.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 02/11/2023] Open
Abstract
Transstomal stent deployment to maintain the patency of stoma in a challenging patient who developed stoma stenosis, is a minimal invasive, novel technique. This is a new and alternative approach in management of stoma stenosis in a difficult case using a biodegradable stent for end colostomy.
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Affiliation(s)
- Feras Aljarad
- Department of General Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK
- Department of Surgery, Wishaw University Hospital, NHS Lanarkshire, Glasgow, UK
| | - Ashutosh Gumber
- Department of Surgery, Wishaw University Hospital, NHS Lanarkshire, Glasgow, UK
| | - Anne Marie McLeary
- Department of Surgery, Wishaw University Hospital, NHS Lanarkshire, Glasgow, UK
| | - Kawan Shalli
- Department of Surgery, Wishaw University Hospital, NHS Lanarkshire, Glasgow, UK
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12
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Saúde-Conde R, Nguyen D, Hendlisz A. Immunotherapies in non-metastatic gastrointestinal cancers. Curr Opin Oncol 2023; 35:334-346. [PMID: 37222204 DOI: 10.1097/cco.0000000000000956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Over the last decade, immune checkpoint inhibitors (ICI) have emerged as cornerstone in the treatment of many metastatic tumour types, including gastrointestinal cancers. In many solid tumours, the effective therapies in the metastatic field are progressively brought into the curative setting. Consequently, earlier tumoural settings have become a field of experiment for immunotherapies. In melanoma, lung, and bladder cancers, excellent results were recorded, possibly explained by differences in the tumour microenvironment between metastatic and non-metastatic settings. In gastrointestinal (GI) Oncology, nivolumab is the first immune checkpoint inhibitor to become a standard-of-care adjuvant treatment after curative surgery for oesophagal or gastroesophageal junction cancer. RECENT FINDINGS We herein discuss the results of a selection of the most relevant studies presented/published over the last 18 months testing immunotherapies in non-metastatic GI cancers. Among immunotherapies, ICI have been investigated in pre-, peri- and postoperative setting across tumour types, alone or in combination with chemo- and/or radiotherapy. Vaccines are also a new field of investigation. SUMMARY Promising results from two studies (NCT04165772 and NICHE-2 study) demonstrating never-seen-before responses to neoadjuvant immunotherapy in MMR deficient (dMMR) colorectal cancers raise hope for improving the patients' outcome and developing organ-sparing strategies in this situation.
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Affiliation(s)
| | - Dan Nguyen
- Department of Medical Oncology, Institut Jules Bordet, The Brussels University Hospital (HUB)
| | - Alain Hendlisz
- Department of Digestive Oncology
- Université Libre de Bruxelles, Brussels, Belgium
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13
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Gao Y, Xiao H, Meng W, Liao J, Chen Q, Zhao G, Li C, Bai L. Locally advanced rectal cancer patients with mismatch repair protein deficiency can obtain better pathological response after regional chemoembolization. Front Oncol 2023; 13:1131690. [PMID: 37182172 PMCID: PMC10174286 DOI: 10.3389/fonc.2023.1131690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
Background and objective Preoperative transcatheter rectal arterial chemoembolization (TRACE) can enhance the pathological response rate in some patients with locally advanced rectal cancer (LARC). However, how to accurately identify patients who can benefit from this neoadjuvant modality therapy remains to be further studied. Deficient mismatch repair (dMMR) protein plays a crucial role in maintaining genome stability. A proportion of patients with rectal cancer are caused by the loss of mismatch repair (MMR) protein. Given the role of MMR in guiding the efficacy in patients with colorectal carcinoma (CRC), this study is designed to evaluate the effect of dMMR status on the response to neoadjuvant therapy through a retrospective analysis. Methods We launched a retrospective study. First, we selected patients with LARC from the database, and these patients had received preoperative TRACE combined with concurrent chemoradiotherapy. Then, the tumor tissue biopsied by colonoscopy before intervention was taken for immunohistochemistry. According to the expression of MLH-1, MSH-2, MSH-6 and PMS-2, these patients were divided into dMMR protein group and proficient MMR (pMMR) protein group. All patients underwent pathological examination at the end of neoadjuvant therapy, either surgically excised tissue or colonoscopically biopsied tissue. The end point was the pathologic complete response (pCR) after TRACE combined with concurrent chemoradiotherapy. Results From January 2013 to January 2021, a total of 82 patients with LARC received preoperative TRACE combined with concurrent chemoradiotherapy, and the treatment was well tolerated. Among 82 patients, there were 42 patients in the pMMR group and 40 patients in the dMMR group. 69 patients returned to the hospital for radical resection. In 8 patients, the colonoscopy showed good tumor regression grade after 4 weeks of interventional therapy and refused surgery. The remaining five patients were neither surgically treated nor reexamined by colonoscopy. 77 patients were eventually enrolled in the study. Individually, the pCR rates of these two groups (10%, 4/40 vs. 43%, 16/37) showed significant difference (P < 0.05). Biomarker analysis indicated that patients with dMMR protein had a better propensity for pCR. Conclusion In patients with LARC, preoperative TRACE combined with concurrent chemoradiotherapy showed good pCR rates, especially in patients with dMMR. Patients with MMR protein defects have a better propensity for pCR.
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Affiliation(s)
- Yuchen Gao
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Hualiang Xiao
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Wenjun Meng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Liao
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Qi Chen
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Guowei Zhao
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Chunxue Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
- *Correspondence: Chunxue Li, ; Lian Bai,
| | - Lian Bai
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
- *Correspondence: Chunxue Li, ; Lian Bai,
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14
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D’Ambrosio F, Pappalardo C, Scardigno A, Maida A, Ricciardi R, Calabrò GE. Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010079. [PMID: 36612395 PMCID: PMC9819694 DOI: 10.3390/ijerph20010079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care. METHODS A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy. RESULTS Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery. CONCLUSIONS PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.
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Affiliation(s)
- Floriana D’Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ciro Pappalardo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Scardigno
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ada Maida
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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15
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Cercek A, Lumish M, Sinopoli J, Weiss J, Shia J, Lamendola-Essel M, El Dika IH, Segal N, Shcherba M, Sugarman R, Stadler Z, Yaeger R, Smith JJ, Rousseau B, Argiles G, Patel M, Desai A, Saltz LB, Widmar M, Iyer K, Zhang J, Gianino N, Crane C, Romesser PB, Pappou EP, Paty P, Garcia-Aguilar J, Gonen M, Gollub M, Weiser MR, Schalper KA, Diaz LA. PD-1 Blockade in Mismatch Repair-Deficient, Locally Advanced Rectal Cancer. N Engl J Med 2022; 386:2363-2376. [PMID: 35660797 PMCID: PMC9492301 DOI: 10.1056/nejmoa2201445] [Citation(s) in RCA: 546] [Impact Index Per Article: 273.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy and radiation followed by surgical resection of the rectum is a standard treatment for locally advanced rectal cancer. A subset of rectal cancer is caused by a deficiency in mismatch repair. Because mismatch repair-deficient colorectal cancer is responsive to programmed death 1 (PD-1) blockade in the context of metastatic disease, it was hypothesized that checkpoint blockade could be effective in patients with mismatch repair-deficient, locally advanced rectal cancer. METHODS We initiated a prospective phase 2 study in which single-agent dostarlimab, an anti-PD-1 monoclonal antibody, was administered every 3 weeks for 6 months in patients with mismatch repair-deficient stage II or III rectal adenocarcinoma. This treatment was to be followed by standard chemoradiotherapy and surgery. Patients who had a clinical complete response after completion of dostarlimab therapy would proceed without chemoradiotherapy and surgery. The primary end points are sustained clinical complete response 12 months after completion of dostarlimab therapy or pathological complete response after completion of dostarlimab therapy with or without chemoradiotherapy and overall response to neoadjuvant dostarlimab therapy with or without chemoradiotherapy. RESULTS A total of 12 patients have completed treatment with dostarlimab and have undergone at least 6 months of follow-up. All 12 patients (100%; 95% confidence interval, 74 to 100) had a clinical complete response, with no evidence of tumor on magnetic resonance imaging, 18F-fluorodeoxyglucose-positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. At the time of this report, no patients had received chemoradiotherapy or undergone surgery, and no cases of progression or recurrence had been reported during follow-up (range, 6 to 25 months). No adverse events of grade 3 or higher have been reported. CONCLUSIONS Mismatch repair-deficient, locally advanced rectal cancer was highly sensitive to single-agent PD-1 blockade. Longer follow-up is needed to assess the duration of response. (Funded by the Simon and Eve Colin Foundation and others; ClinicalTrials.gov number, NCT04165772.).
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Affiliation(s)
- Andrea Cercek
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Melissa Lumish
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Jenna Sinopoli
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Jill Weiss
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Jinru Shia
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Michelle Lamendola-Essel
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Imane H El Dika
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Neil Segal
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Marina Shcherba
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Ryan Sugarman
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Zsofia Stadler
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Rona Yaeger
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - J Joshua Smith
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Benoit Rousseau
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Guillem Argiles
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Miteshkumar Patel
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Avni Desai
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Leonard B Saltz
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Maria Widmar
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Krishna Iyer
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Janie Zhang
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Nicole Gianino
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Christopher Crane
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Paul B Romesser
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Emmanouil P Pappou
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Philip Paty
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Julio Garcia-Aguilar
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Mithat Gonen
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Marc Gollub
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Martin R Weiser
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Kurt A Schalper
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
| | - Luis A Diaz
- From the Division of Solid Tumor Oncology (A.C., M.L., J. Sinopoli, J.W., M.L.-E., I.H.E.D., N.S., M.S., R.S., Z.S., R.Y., B.R., G.A., M.P., A.D., L.B.S., L.A.D.) and the Departments of Pathology (J. Shia), Surgery (J.J.S., M.W., E.P.P., P.P., J.G.-A., M.R.W.), Radiation Oncology (C.C., P.B.R.), Epidemiology and Biostatistics (M. Gonen), and Radiology (M. Gollub), Memorial Sloan Kettering Cancer Center, New York; and the Department of Pathology, Yale University School of Medicine, New Haven, CT (K.I., J.Z., N.G., K.A.S.)
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Kostov G, Dimov R, Doykov M. Diverting ileostomy in low anterior resection: single center retrospective analysis. POLISH JOURNAL OF SURGERY 2022; 94:26-32. [DOI: 10.5604/01.3001.0015.8171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Introduction:</b> Low anterior resection (LAR) is the standard procedure for distal rectal cancer allowing anal sphincter preservation. Anastomotic leakage remains one of the most dangerous complications following LAR and its management is difficult. </br></br> <b>Aim:</b> This study reviews our experience of LAR with and without protective ileostomy (PI). </br></br> <b> Methods:</b> One hundred ninety-nine patients undergoing LAR resection for low rectal cancer in this centre during the period 2015–2019 were divided retrospectively into two groups. Group A underwent rectal resection and coloanal/rectal anastomosis with diverting ileostomy and group B without ileostomy. </br></br> <b> Results:</b> Among our patients, 20 had a covering ileostomy (stoma group);179 did not (control group). The stoma group comprised 14 men and 6 women ranging in age from 36 to 89 years (mean, 64.2 ± 10.5 years). Conventional v. minimally invasive surgery was 6/14. Anastomotic leakage occurred in 16/179 (8.93%) patients without a PI, and in 6/20 (30%) with a stoma (Tab. I.). Of the 16 patients experiencing an anastomotic leak, 3 (18.75%) from Group A and 5 (83.33%) from Group B were classified as Grade B leakage and were treated conservatively. As many as 13/16 (81.25%) in Group A and 1/6 (16.77%) in Group B were classified as Grade C leakage and required emergency surgery. </br></br> <b>Conclusion:</b> These results do not show a preventive effect on the occurrence of anastomotic leakage in low anterior resection, but may significantly reduce the need for further surgery due to septic complications in the early postoperative period. Selection of patients for protective ileostomy requires great care as its creation and closure are associated with severe complications.
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Affiliation(s)
- Gancho Kostov
- Department of Special Surgery, Medical University - Plovdiv, Bulgaria, University Hospital “Kaspela” - Plovdiv, Bulgaria
| | - Rosen Dimov
- Department of Special Surgery, Medical University - Plovdiv, Bulgaria, University Hospital “Kaspela” - Plovdiv, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical University - Plovdiv, Bulgaria, University Hospital “Kaspela” - Plovdiv, Bulgaria
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Luo J, Singh D, Zhang F, Yang X, Zha X, Jiang H, Yang L, Yang H. Comparison of the extraperitoneal and transperitoneal routes for permanent colostomy: a meta-analysis with RCTs and systematic review. World J Surg Oncol 2022; 20:82. [PMID: 35279174 PMCID: PMC8918274 DOI: 10.1186/s12957-022-02547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Aim To assess the efficacy of extraperitoneal colostomy (EPC) in preventing stoma-related complications. Background Transperitoneal colostomy (TPC) is a widely used surgical approach. However, TPCs have been reported to have increased risks of stoma-related complications, such as parastomal hernias, stomal retraction, and stomal prolapse. The purpose of EPC is to reduce these complications. However, there is still a lack of evidence-based studies. Materials and methods MEDLINE, EMBASE, Web of Science, Scopus, MOOSE, PubMed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. The meta-analysis was performed with RevMan 5.4 software. Results This study included 5 eligible RCTs. Compared with the TPC group, the EPC group had lower incidence rates of parastomal hernias (RR, 0.14; 95% CI, 0.04–0.52, P = 0.003, I2 = 0%) and stomatal prolapse (RR, 0.27; 95% CI, 0.08–0.95, P = 0.04, I2 = 0%), but a higher rate of defecation sensation (RR, 3.51; 95% CI, 2.47–5.0, P < 0.00001, I2 = 37%). No statistically significant differences were observed in stoma retraction, colostomy construction time, stoma ischemia, or stoma necrosis. Conclusion Extraperitoneal colostomies are associated with lower rates of postoperative complications than transperitoneal colostomies. A randomized controlled trial meta-analysis found that permanent colostomies after abdominoperineal resection resulted in better outcomes.
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Enomoto H, Suwa K, Takeuchi N, Hannya Y, Tsukazaki Y, Ushigome T, Okamoto T, Eto K. Risk of Outlet Obstruction Associated With Defunctioning Loop Ileostomy in Rectal Cancer Surgery. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:465-470. [PMID: 35403166 PMCID: PMC8962870 DOI: 10.21873/cdp.10062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/01/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient's quality of life and prolongs hospitalization. PATIENTS AND METHODS A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer. RESULTS Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO. CONCLUSION When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.
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Affiliation(s)
- Hiroya Enomoto
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Nana Takeuchi
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Yoshito Hannya
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Yuhei Tsukazaki
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Takuro Ushigome
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Tomoyoshi Okamoto
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University Hospital, Tokyo, Japan
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Zelga P, Kluska P, Zelga M, Piasecka-Zelga J, Dziki A. Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery: A Scoping Review. J Wound Ostomy Continence Nurs 2021; 48:415-430. [PMID: 34495932 DOI: 10.1097/won.0000000000000796] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. DESIGN Scoping literature review. SEARCH STRATEGY Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. FINDINGS/CONCLUSIONS We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. IMPLICATIONS Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.
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Affiliation(s)
- Piotr Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Piotr Kluska
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marta Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Joanna Piasecka-Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
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Abstract
BACKGROUND We describe our experiences caring for a patient with a peristomal fistula (PF), characterized by suppuration from a peristomal abscess. The challenges associated with this case included management of a complex fistula and prevention of abdominal necrotizing fasciitis and peritonitis. CASE A 63-year-old man presented with severe peristomal swelling and pain resulting from an abscess adjacent to his ileostomy. He was malnourished and depressed. He underwent a low anterior resection (Dixon procedure) for rectal cancer 2 years ago and an abdominoperineal resection (Miles procedure) for the recurrence of rectal carcinoma 1 year later. In addition, he underwent bowel resection with the creation of an ileostomy due to intestinal obstruction caused by a second recurrence approximately 1 month prior to this admission. Following evaluation of the fistula anatomy, incision and drainage of the abscess was performed. Diversion of the effluent was used to control infection and promote fistula closure. A registered dietitian and a psychologist were consulted to optimize nutrition and treat his depression. After 20 days of treatment, the patient recovered and was safely discharged. CONCLUSION Peristomal fistula management should include anatomical assessment, incision and drainage of the abscess, diversion to control effluent, and skin protection. For complex cases, the coordinated efforts of the interdisciplinary team are imperative.
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Seifarth C, Augustin LN, Lehmann KS, Stroux A, Lauscher JC, Kreis ME, Holmer C. Assessment of Risk Factors for the Occurrence of a High-Output Ileostomy. Front Surg 2021; 8:642288. [PMID: 34095201 PMCID: PMC8176110 DOI: 10.3389/fsurg.2021.642288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Ileostomy is often required in patients undergoing bowel resections for inflammatory bowel diseases (IBD), colorectal cancer, and emergencies. Unfortunately, some patients develop a high-output stoma (HOS). This condition affects homeostasis and may be life threatening. We aimed to identify possible risk factors for the development of HOS. Patients and methods: From 2012 to 2018, 296 patients who underwent ileostomy at Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin were retrospectively analyzed. Emergency operations were included. Diverting ileostomy, end ileostomies and anastomotic stomata with at least part ileum, were examined. HOS was defined as stoma output of more than 1,000 mL per day for more than 3 days. Univariate and multivariable analyses were used to detect potential risk factors for the development of HOS. Results: 41 of 296 patients developed HOS (13.9%). Mortality was 0.3%. In the univariate analysis, age (p < 0.002), diagnosis (Crohn's disease, p = 0.005), arterial hypertension (p = 0.023), surgical procedure (right-sided colectomy, small bowel resection, p < 0.001), open technique (p < 0.002), emergencies (p = 0.014), and anastomotic ileostomy (p < 0.001) were identified as risk factors. In the multivariable logistic regression, older age, diagnosis (Crohn's disease) and surgical procedure (right-sided colectomy, separate ileostomy, small bowel resection) remained significant risk factors. Conclusion: The occurrence of HOS is a relevant problem after ileostomy. The identification of risk factors for a high-output may be helpful for monitoring, early diagnosis and initiation of therapy as well as in the planning of close follow-up care.
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Affiliation(s)
- Claudia Seifarth
- Department of General-, Visceral- and Vascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leonard N Augustin
- Department of General-, Visceral- and Vascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kai S Lehmann
- Department of General-, Visceral- and Vascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrea Stroux
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes C Lauscher
- Department of General-, Visceral- and Vascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin E Kreis
- Department of General-, Visceral- and Vascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Holmer
- Department of General and Visceral Surgery, St. Joseph Hospital, Berlin, Germany
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Hashimoto H, Kaku-Ito Y, Furue M, Ito T. Mucosal Invasion, but Not Incomplete Excision, Has Negative Impact on Long-Term Survival in Patients With Extramammary Paget's Disease. Front Oncol 2021; 11:642919. [PMID: 33937045 PMCID: PMC8082157 DOI: 10.3389/fonc.2021.642919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Extramammary Paget’s disease (EMPD) sometimes spreads from the skin to mucosal areas, and curative surgical excision of these areas is challenging. The aim of this study is to analyze the impact of mucosal involvement and surgical treatment on the survival of patients with EMPD. Methods We conducted a retrospective review of 217 patients with EMPD. We also assessed the associations between tumor involvement in boundary areas (anal canal, external urethral meatus, vaginal introitus), prognostic factors, and survival in 198 patients treated with curative surgery. Results Of 217 patients, 75 (34.6%) had mucosal boundary area involvement. Lesions in these areas were associated with frequent lymphovascular invasion (p = 0.042), lymph node metastasis (p = 0.0002), incomplete excision (p < 0.0001), and locoregional recurrence (p < 0.0001). Boundary area involvement was an independent prognostic factor associated with disease-specific survival, per multivariate analysis (HR: 11.87, p = 0.027). Incomplete excision was not significantly correlated with disease-specific survival (HR: 1.05, p = 0.96). Conclusion Boundary area tumor involvement was a major risk factor for incomplete excision, local recurrence, and poor survival outcomes. However, incomplete removal of primary tumors was not significantly associated with poor prognosis. A less invasive surgical approach for preserving anogenital and urinary functions may be acceptable as the first-line treatment for resectable EMPD.
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Affiliation(s)
- Hiroki Hashimoto
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yumiko Kaku-Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Roveron G, Barbierato M, Rizzo G, Parini D, Bondurri A, Veltri M, Pata F, Cattaneo F, Tafuri A, Forni C, Ferrara F. Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary. J Wound Ostomy Continence Nurs 2021; 48:137-147. [PMID: 33690248 DOI: 10.1097/won.0000000000000745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. METHODS Scoping review and generation of evidence and consensus-based clinical guidelines. SEARCH STRATEGY The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. FINDINGS/CONCLUSIONS This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.
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Affiliation(s)
- Gabriele Roveron
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Barbierato
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gianluca Rizzo
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Dario Parini
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Andrea Bondurri
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marco Veltri
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Pata
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Cattaneo
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandro Tafuri
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Cristiana Forni
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Ferrara
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
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Hashmi ZG, Dalton MK, Sheikh SS, McCarty JC, Salim A, Haider AH. National estimates of intestinal ostomy creation and reversal for trauma. J Trauma Acute Care Surg 2021; 90:459-465. [PMID: 33617196 DOI: 10.1097/ta.0000000000003022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intestinal ostomy creation after trauma is selectively indicated for destructive colon and rectal injuries. However, the nationwide rates of creation of ostomies for trauma and their reversal are not known. The objective of this study was to ascertain national estimates of trauma ostomy creation and reversal. METHODS Weighted analysis of Healthcare Cost and Utilization Project Nationwide Readmissions Database 2014 to 2015 was performed. Adult trauma patients (≥16 years) with a hollow viscus injury were included. Patients with preexisting ostomies and permanent ostomies and those who died within 48 hours of admission were excluded. Rates of ostomy creation and same admission ostomy reversal were calculated. Rates of postdischarge ostomy reversal were calculated using the Kaplan-Meier estimator. Multivariable Cox proportional hazards model was used to determine factors associated with postdischarge trauma ostomy reversal. RESULTS A total of 22,542 patients sustained a hollow viscus injury resulting in the creation of 2,145 ostomies (9.6%). The rate of same-admission ostomy reversal was 0.7% (n = 16). At 1, 3, 6, and 9 months, the cumulative stoma reversal rates were 0%, 7.6%, 31.0%, and 43.1%, respectively. The mean ± SD time from ostomy creation to reversal was 123 ± 6.7 days for those undergoing reversal. Injury Severity Score greater than 9 was significantly associated with ostomy nonreversal after discharge (hazard ratio, 0.41; 95% confidence interval, 0.26-0.66). Age, sex, insurance status, penetrating injury, Charlson Comorbidity Index, and hospital teaching status were not significantly associated with ostomy reversal. CONCLUSION The nationwide rate of ostomy creation after trauma is nearly 10%. At 6 months postinjury, only one third of patients had undergone ostomy reversal. Future study is needed to understand patient and provider-level factors associated with trauma ostomy reversal. LEVEL OF EVIDENCE Epidemiology, level III.
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Affiliation(s)
- Zain G Hashmi
- From the Center for Surgery and Public Health, Department of Surgery (Z.G.H., M.K.D., J.C.M., A.S., A.H.H.), Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery (Z.G.H.), Sinai Hospital of Baltimore, Baltimore, Maryland; Department of Surgery (S.S.S.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (J.C.M.), St. Elizabeth's Medical Center, Boston, Massachusetts; and Medical College (A.H.H.), Aga Khan University, Karachi, Pakistan
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Sirimarco MT, Moraes BHXDE, Oliveira DRLSDE, Oliveira AGDE, Schlinz PAF. Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings. Rev Col Bras Cir 2021; 48:e20202644. [PMID: 33503140 PMCID: PMC10846395 DOI: 10.1590/0100-6991e-20202644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/17/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. METHOD a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. RESULTS 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). CONCLUSIONS most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.
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Affiliation(s)
- Mauro Toledo Sirimarco
- - Universidade Federal de Juiz de Fora, Faculdade de Medicina - Departamento de Cirurgia - Juiz de Fora - MG - Brasil
| | | | | | - Alfeu Gomes DE Oliveira
- - Prefeitura Municipal de Juiz de Fora, Secretaria de Saúde - Departamento de Clínicas Especializadas - Juiz de Fora - MG - Brasil
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Vriesman MH, Noor N, Koppen IJ, Di Lorenzo C, de Jong JR, Benninga MA. Outcomes after enterostomies in children with and without motility disorders: A description and comparison of postoperative complications. J Pediatr Surg 2020; 55:2413-2418. [PMID: 32600839 DOI: 10.1016/j.jpedsurg.2020.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung's disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease). METHODS We performed a retrospective study of children who underwent an enterostomy procedure at our institution. The number and type of complications and subsequent reoperations after ostomy formation were determined. Complications were scored using the Clavien-Dindo classification. A complication of ≥ grade III-b was considered a high-grade complication. RESULTS 129 children with an ileostomy and 61 children with a colostomy were included. Of these, 62 children (32.6%) had motility disorders; functional constipation (n=40), Hirschsprung's disease (n=18) and PIPO (n=4). The total prevalence of complications was 73.2%. Comparing the perioperative data, children with motility disorders significantly more often underwent a laparoscopic procedure (59.7% vs. 10.9%, p=0.000) and had an end stoma-configuration (37.1% vs. 14.1%, p=0.000) as compared to children without motility disorders. Children with motility problems had a higher complication rate (88.7% vs. 65.5%, OR 4.1, 95% CI 1.7-9.8, p=0.001) compared to children without motility problems, and a larger proportion of complications was classified as high-grade complications (61.8% vs. 31.0% p =0.002). CONCLUSION A high complication rate after enterostomy formation was detected. Children with gastrointestinal motility disorders had more and more severe complications as compared to children without motility disorders. LEVEL OF EVIDENCE Level III TYPE OF STUDY: Retrospective comparative study.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Najia Noor
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilan J Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Sakurai Kimura CM, Scanavini Neto A, Queiroz NSF, Horvat N, Camargo MGM, Borba MR, Sobrado CW, Cecconello I, Nahas SC. Abdominal Surgery in Crohn's Disease: Risk Factors for Complications. Inflamm Intest Dis 2020; 6:18-24. [PMID: 33850835 DOI: 10.1159/000510999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Abdominal surgery in patients with Crohn's disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. Methods A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. Results Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, p = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12-9.46 and OR 2.94, 95% CI 0.98-9.09, respectively). Conclusion Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.
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Affiliation(s)
- Cintia Mayumi Sakurai Kimura
- Department of Colon and Rectal Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Arceu Scanavini Neto
- Department of Colon and Rectal Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Natally Horvat
- Department of Radiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Marcelo Rodrigues Borba
- Department of Colon and Rectal Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos Walter Sobrado
- Department of Colon and Rectal Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ivan Cecconello
- Department of Colon and Rectal Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Sergio Carlos Nahas
- Department of Colon and Rectal Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Validation and Clinical Experience With a Turkish Language Version of the Pittman Ostomy Complication and Severity Index. J Wound Ostomy Continence Nurs 2020; 47:45-49. [PMID: 31800567 DOI: 10.1097/won.0000000000000600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the content validity and interrater reliability of a Turkish language version of the Pittman Ostomy Complication and Severity Index (OCSI). DESIGN Psychometric evaluation of instrument. SUBJECTS AND SETTING The sample comprised 90 individuals living with an ostomy for 2 to 6 months. Their mean age was 59.48 years (SD 13.292); 52.2% were female. Almost two-thirds (73.3%, n = 66) had experienced at least 1 ostomy complication. The study was conducted in the Wound and Stoma Therapy Unit of the Dokuz Eylül University Hospital General Surgery Clinic and Polyclinic in Izmir, Turkey. METHODS A Turkish language version of the OCSI was created using a translation, back-translation technique. The instrument's content validity was analyzed by 26 experts. Interrater reliability test was evaluated using Cohen's κ and intraclass correlation coefficients. Data were collected between January 15, 2017 and July 30, 2017 through face-to-face interviews conducted in our Wound and Stoma Therapy Unit. RESULTS The overall content validity index was 0.95. Cohen's κ coefficient varied from 0.70 and 1.0 for all items. The Pearson correlation coefficient and intraclass correlation coefficient were 0.982 (P = .000) and 0.986 (P = .000), respectively, indicating good internal consistency. The most prevalent complications were leakage (41.1%), peristomal moisture-associated skin damage (42.2%), and stomal retraction (27.7%). CONCLUSIONS Findings indicate that the Turkish language version of the Pittman OCSI is a reliable and valid instrument for assessment of presence and severity of early postoperative complications in individuals with an ostomy. We found the instrument parsimonious, easy-to-use, and clinically practical. It can be used to determine appropriate interventions to prevent or treat complications and evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.
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Khan MF, Cahill R. Indocyanine green and fluorescence angiography to detect and correct stoma ischaemia intra-operatively - a video vignette. Colorectal Dis 2020; 22:594-595. [PMID: 31876374 DOI: 10.1111/codi.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/29/2019] [Indexed: 02/08/2023]
Affiliation(s)
- M F Khan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.,UCD Centre for Precision Surgery, Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - R Cahill
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.,UCD Centre for Precision Surgery, Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland
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Stoma-Related Complications Following Ostomy Surgery in 3 Acute Care Hospitals. J Wound Ostomy Continence Nurs 2020; 47:32-38. [DOI: 10.1097/won.0000000000000605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goldstine J, van Hees R, van de Vorst D, Skountrianos G, Nichols T. Factors influencing health-related quality of life of those in the Netherlands living with an ostomy. ACTA ACUST UNITED AC 2019; 28:S10-S17. [DOI: 10.12968/bjon.2019.28.22.s10] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: this study examined the health-related quality of life (HRQoL) and wellbeing of people in the Netherlands who had undergone ostomy surgery. Aims: to assess how an ostomy population perceives their HRQoL and determine key stressors that influence HRQoL in this population. Methods: a cross-sectional survey, including the City of Hope National Medical Center Quality of Life Questionnaire for patients with an ostomy and a Visual Analogue Scale measuring HRQoL, was used to evaluate postsurgical patients. Findings: people with an ostomy in the Netherlands have a generally positive HRQoL, but this may be affected by peristomal skin irritation, experience of leakage on to the peristomal skin and whether their surgery was planned. Conclusions: access to specialist nurse support and products designed to prevent leakage and prevent skin irritation—two key drivers of HRQoL—may be able to maximise an individual's health status throughout their lifelong journey as a person with an ostomy.
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Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience. BMC Gastroenterol 2019; 19:157. [PMID: 31462228 PMCID: PMC6714288 DOI: 10.1186/s12876-019-1070-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An intestinal stoma, though a life-saving procedure on the care of many gastrointestinal conditions, carries significant number of complications. This study describes the common indications, complications, and management of stomas and identifies the factors that are associated with these complications in a tertiary care hospital in Tanzania. METHODS A cross-sectional study of patients with intestinal stomas was conducted at Bugando Medical Centre (BMC) between July 2016 and June 2017. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. RESULTS A total of 167 patients (M: F = 1.2:1) were enrolled in the study. The mean age at diagnosis was 0.6 ± 1.4 years for children and mean age for adults was 36.7 ± 15.8 years. Anorectal malformation (110, 89.4%) was the most common indication for intestinal stoma formation in children, while bowel perforation (14, 31.8%) was the main indications in adults. The sigmoid colon (137, 82.0%) was the most common anatomical site for stoma formation followed by the ileum (18, 10.8%). Stoma prolapse (18, 41.9%) was the most frequent complication of a stoma, whereas, surgical site infection (9, 34.6%) was the most frequent complication after stoma closure. Thirty five (26.7.%) of the children developed stomal complications, while only 8 (22.2%) of the adults developed complications. The level of training of operating surgeon and timing of surgery were the main predictors of stoma-related complications (p < 0.034 and 0.013), whereas the level of training of the operating surgeon and the type of stoma closure were significantly associated with the complications related to stoma closure (p < 0.001). CONCLUSION The intestinal stomas performed at BMC are associated with various complications, which in turn, become a burden to the patients. The insights observed in the current study may apply to other tertiary hospitals in Tanzania and Africa at large. We suggest that the keystones for improvement and control in the formation and complications of intestinal stomas are the following; colostomy formation should rarely be done in transverse colon, the procedure should be carried out by senior doctors (specialist) or junior doctors under close and direct supervision of the specialists, using proper meticulous techniques, and the need to determine and/or improve techniques for early detection of complications.
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Perissotto S, Breder JDSC, Zulian LR, Oliveira VXD, Silveira NID, Alexandre NMC. Ações de enfermagem para prevenção e tratamento de complicações em estomias intestinais. ESTIMA 2019. [DOI: 10.30886/estima.v17.638_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objetivo: Identificar na literatura as principais ações de enfermagem para prevenção e tratamento das complicações mais frequentes nas estomias de eliminação intestinal. Método: Revisão integrativa que seguiu as fases: identificação do tema e seleção da questão de pesquisa; estabelecimento de critérios para inclusão e exclusão de estudos; categorização dos estudos; avaliação dos estudos incluídos na revisão integrativa; interpretação dos resultados; e síntese do conhecimento. O período utilizado foi de janeiro de 2007 a junho de 2017, nas bases de dados e nos portais Medical Literature Analysis and Retrieval System Online (MEDLINE), Biblioteca Virtual em Saúde (BVS), Excerpta Medica database (Embase), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Scopus Info Site. Os descritores utilizados foram estomia, enfermagem e complicações
pós-operatórias. Resultados: Onze artigos responderam à questão norteadora: quais ações de enfermagem podem ser utilizadas na prevenção e tratamento das complicações em estomias intestinais? As complicações mais abordadas foram hérnia paraestomal, estenose, retração da estomia e separação mucocutânea. As ações de enfermagem mais citadas foram demarcação pré-operatória e acompanhamento com enfermeiro especialista no pré- e pós-operatório. Conclusão: A atuação do enfermeiro estomaterapeuta é essencial para a prevenção e tratamento das complicações em estomias intestinais, porém mais estudos de alto impacto são necessários para nortear suas ações.
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Perissotto S, Breder JDSC, Zulian LR, Oliveira VXD, Silveira NID, Alexandre NMC. Nursing actions for prevention and treatment of complications in intestinal stomies. ESTIMA 2019. [DOI: 10.30886/estima.v17.638_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: To identify in the literature the main nursing actions for prevention and treatment of the most frequent complications in intestinal elimination stomies. Methods: Integrative review that followed the phases: identification of the theme and selection of the research question; establishment of criteria for inclusion and exclusion of studies; categorization of studies; evaluation of studies included in the integrative review; interpretation of results; and synthesis of knowledge. The period used was from January 2007 to June 2017, in the databases and in the portals Medical Literature Analysis and Retrieval System Online (MEDLINE), Biblioteca Virtual em Saúde (BVS), Excerpta Medica database (Embase), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus Info Site. The descriptors used were ostomy, nursing and postoperative complications. Results: Eleven articles answered the guiding question: which nursing actions can be used to prevent and treat complications in intestinal ostomies? The most commonly reported complications were a parastomal hernia, stenosis, retraction of the ostomy and mucocutaneous separation. The most cited nursing actions were preoperative demarcation and follow-up with specialist nurses in the pre- and postoperative periods. Conclusion: The role of the stomatherapist nurse is essential for the prevention and treatment of complications in the intestinal ostomies, but more studies of high impact are necessary to guide their actions.
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Weerink LBM, Gant CM, van Leeuwen BL, de Bock GH, Kouwenhoven EA, Faneyte IF. Long-Term Survival in Octogenarians After Surgical Treatment for Colorectal Cancer: Prevention of Postoperative Complications is Key. Ann Surg Oncol 2018; 25:3874-3882. [PMID: 30244418 PMCID: PMC6245105 DOI: 10.1245/s10434-018-6766-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 12/13/2022]
Abstract
Background Whether to treat octogenarians with colorectal cancer (CRC) in the same manner as younger patients remains a challenging issue. The purpose of this study was to analyse postoperative complications and long-term survival in a consecutive cohort of octogenarians who were surgically treated for CRC. Methods Octogenarians with primary CRC suitable for curative surgery between January 2008 and December 2011 were included. Data about comorbidities, tumour stage, and complications were retrospectively collected from patient files. Data about survival were retrieved with use of the Dutch database for persons and addresses. To identify factors associated with severe postoperative complications and postoperative survival, logistic regression analyses, and Cox regression analyses were performed. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CI) were estimated. Results In a series of 108 octogenarians, median age was 83 years (range 80–94 years). Median follow-up was 47 (range 1–107) months. Major postoperative complications occurred in 25% of the patients. No risk factors for development of severe postoperative complications could be identified. The 30-day mortality was 7%; 1- and 5-year mortality was 19% and 56%, respectively. Overall median survival was 48 months: 66 months in patients without complications versus 13 months in patients with postoperative complications. Postoperative complications were most predictive of decreased survival (HR 3.16; 95% CI 1.79–5.59), even including tumour characteristics, comorbidity, and emergency surgery. Conclusions Long-term survival in octogenarians deemed fit for surgery is reasonably good. Prevention of major postoperative complications could further improve clinical outcome.
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Affiliation(s)
- Linda B M Weerink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department Surgery, Hospital Group Twente, Almelo, The Netherlands.
| | - Christina M Gant
- Department Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Ian F Faneyte
- Department Surgery, Hospital Group Twente, Almelo, The Netherlands
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Berger A, Inglese G, Skountrianos G, Karlsmark T, Oguz M. Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier: Findings From a Long-Term Cost-effectiveness Analysis. J Wound Ostomy Continence Nurs 2018; 45:146-155. [PMID: 29438140 PMCID: PMC5865496 DOI: 10.1097/won.0000000000000416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the cost-effectiveness of a ceramide-infused skin barrier (CIB) versus other skin barriers (standard of care) among patients who have undergone ostomy creation. DESIGN Cost-effectiveness analysis, based on a decision-analytic model that was estimated using data from the ADVOCATE (A Study Determining Variances in Ostomy Skin Conditions And The Economic Impact) trial, which investigated stoma-related healthcare costs over 12 weeks among patients who recently underwent fecal ostomy, and from other sources. SUBJECTS AND SETTING Analysis was based on a hypothetical cohort of 1000 patients who recently underwent fecal ostomy; over a 1-year period, 500 patients were assumed to use CIB and 500 were assumed to use standard of care. METHODS We adapted a previous economic model to estimate expected 1-year costs and outcomes among persons with a new ostomy assumed to use CIB versus standard of care. Outcomes of interest included peristomal skin complications (PSCs) (up to 2 during the 1-year period of interest) and quality-adjusted life days (QALDs); QALDs vary from 1, indicating a day of perfect health to 0, indicating a day with the lowest possible health (deceased). Subjects were assigned QALDs on a daily basis, with the value of the QALD on any given day based on whether the patient was experiencing a PSC. Costs included those related to skin barriers, ostomy accessories, and care of PSCs. The incremental cost-effectiveness of CIB versus standard of care was estimated as the incremental cost per PSC averted and QALD gained, respectively; net monetary benefit of CIB was also estimated. All analyses were run using the perspective of an Australian payer. RESULTS On a per-patient basis, use of CIB was expected over a 1-year period to result in 0.16 fewer PSCs, an additional 0.35 QALDs, and a savings of A$180 (Australian dollars, US $137) in healthcare costs all versus standard of care. Management with CIB provided a net monetary benefit (calculated as the product of maximum willingness to pay for 1 QALD times additional QALDs with CIB less the incremental cost of CIB) of A$228 (US $174). Probabilistic sensitivity analysis was also completed; it revealed that 97% of model runs resulted in fewer expected PSCs with CIB; 92% of these runs resulted in lower expected costs with CIB. CONCLUSIONS Findings suggest that the CIB is a cost-effective skin barrier for persons living with an ostomy.
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Affiliation(s)
- Ariel Berger
- Correspondence: Ariel Berger, MPH, 500 Totten Pond Rd, 5th Floor, Waltham, MA 02451 ()
| | - Gary Inglese
- Ariel Berger, MPH, Evidera Inc, Waltham, Massachusetts
- Gary Inglese, RN, MBA, Hollister Incorporated, Libertyville, Illinois
- George Skountrianos, MS, Hollister Incorporated, Libertyville, Illinois
- Tonny Karlsmark, MD, DMSc, University of Copenhagen, Denmark
- Mustafa Oguz, PhD, Evidera Inc, Hammersmith, London, United Kingdom
| | - George Skountrianos
- Ariel Berger, MPH, Evidera Inc, Waltham, Massachusetts
- Gary Inglese, RN, MBA, Hollister Incorporated, Libertyville, Illinois
- George Skountrianos, MS, Hollister Incorporated, Libertyville, Illinois
- Tonny Karlsmark, MD, DMSc, University of Copenhagen, Denmark
- Mustafa Oguz, PhD, Evidera Inc, Hammersmith, London, United Kingdom
| | - Tonny Karlsmark
- Ariel Berger, MPH, Evidera Inc, Waltham, Massachusetts
- Gary Inglese, RN, MBA, Hollister Incorporated, Libertyville, Illinois
- George Skountrianos, MS, Hollister Incorporated, Libertyville, Illinois
- Tonny Karlsmark, MD, DMSc, University of Copenhagen, Denmark
- Mustafa Oguz, PhD, Evidera Inc, Hammersmith, London, United Kingdom
| | - Mustafa Oguz
- Ariel Berger, MPH, Evidera Inc, Waltham, Massachusetts
- Gary Inglese, RN, MBA, Hollister Incorporated, Libertyville, Illinois
- George Skountrianos, MS, Hollister Incorporated, Libertyville, Illinois
- Tonny Karlsmark, MD, DMSc, University of Copenhagen, Denmark
- Mustafa Oguz, PhD, Evidera Inc, Hammersmith, London, United Kingdom
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Wang X, Shen B. Management of Crohn's Disease and Complications in Patients With Ostomies. Inflamm Bowel Dis 2018; 24:1167-1184. [PMID: 29722891 DOI: 10.1093/ibd/izy025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Indexed: 12/13/2022]
Abstract
Fecal diversion with ostomy construction can be a temporary or definitive surgical measure for the treatment of refractory inflammatory bowel disease (IBD). However, the fecal diversion surgery is associated with various stoma, peristomal complications, and recurrence or occurrence of de novo small bowel Crohn's disease (CD). Stoma complications often need enterostomal therapy or surgical revision. Peristomal cutaneous lesions, such as pyoderma gangrenosum, usually require immunomodulator or biological therapy. Routine monitoring for occurrence or recurrence of CD with endoscopy or imaging should be performed, and prophylaxis with mesalamines, antibiotics, immunomodulators, or anti-TNFα or anti-integrin agents is needed for patients at risk. Those agents, along with corticosteroids, may also be used for the treatment of CD of the neo-small intestine, particularly inflammatory and fistulizing phenotypes. Endoscopic balloon dilation or endoscopic stricturotomy via stoma is safe and feasible to treat short (<4-5 cm), straight strictures in the neo-small intestine. Medically or endoscopically refractory fibrostenotic disease usually requires surgical intervention, with bowel-sparing stricturoplasty being the surgical treatment of choice.
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Affiliation(s)
- Xinying Wang
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bo Shen
- Center for Inflammatory Bowel Diseases, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
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A Randomized Controlled Trial Determining Variances in Ostomy Skin Conditions and the Economic Impact (ADVOCATE Trial). J Wound Ostomy Continence Nurs 2018; 45:37-42. [PMID: 29300287 PMCID: PMC5757663 DOI: 10.1097/won.0000000000000389] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramide-infused ostomy skin barriers and control skin barriers. DESIGN The ADVOCATE trial is a multi-centered randomized controlled trial, and double-blinded international study with an adaptive design. SUBJECTS AND SETTING The sample comprised 153 adults from 25 sites from the United States, Canada, and Europe. Participants were seen in hospital and outpatient care settings. METHODS Data were collected by investigators at each site during face-to-face visits and during telephone check-in calls between visits. Cost of care data were collected using a questionnaire developed specifically for the study. The peristomal skin was assessed using the Ostomy Skin Tool. Health-related quality of life was measured using the SF-12v2. Patient-reported outcomes were collected using a patient-centered study-specific questionnaire. Cost of care was analyzed via analysis of covariance comparing total cost of care for 12 weeks between the 2 groups. The incidence of PSC was analyzed via Barnard's exact test comparing the incidence of PSCs between the control and treatment groups. Tertiary outcomes were exploratory in nature and not statistically powered. RESULTS Use of the ceramide-infused barrier significantly reduced stoma-related cost of care over a 12-week period, resulting in a $36.46 decrease in cost (14% relative decrease). The adjusted average costs were $223.73 in the treatment group and $260.19 in the control group (P = .017). The overall incidence of PSCs in the study was 47.7%; PSC incidence was 40.5% for the treatment group versus 55.4% for controls (P = .069, 95% confidence interval of the difference: -1.2 to 30.4). Significantly more participants using the ceramide-infused skin barrier were "very satisfied" with barrier performance (75% vs 55%; P = .033), prevention of leakage (63% vs 38%; P < .01), and prevention of itching (53% vs 31%; P = .016). General postoperative improvement in health-related quality of life was noted in both groups. CONCLUSIONS The use of a ceramide-infused barrier significantly decreased cost and increased satisfaction with patient-reported outcomes.
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Sier MF, Wisselink DD, Ubbink DT, Oostenbroek RJ, Veldink GJ, Lamme B, van Duijvendijk P, van Geloven AAW, Eijsbouts QAJ, Bemelman WA. Randomized clinical trial of intracutaneously versus transcutaneously sutured ileostomy to prevent stoma-related complications (ISI trial). Br J Surg 2018; 105:637-644. [PMID: 29493785 PMCID: PMC5947256 DOI: 10.1002/bjs.10750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/27/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Abstract
Background Ileostomy construction is a common procedure but can be associated with morbidity. The stoma is commonly secured to the skin using transcutaneous sutures. It is hypothesized that intracutaneous sutures result in a tighter adherence of the peristomal skin to the stoma plate to prevent faecal leakage. The study aimed to compare the effect of intracutaneous versus transcutaneous suturing of ileostomies on faecal leakage and quality of life. Methods This randomized trial was undertaken in 11 hospitals in the Netherlands. Patients scheduled to receive an ileostomy for any reason were randomized to intracutaneous or transcutaneous suturing (IC and TC groups respectively). The primary outcome was faecal leakage. Secondary outcomes were stoma‐related quality of life and costs of stoma‐related materials and reinterventions. Results Between April 2011 and February 2016, 339 patients were randomized to the IC (170) or TC (169) group. Leakage rates were higher in the IC than in the TC group (52·4 versus 41·4 per cent respectively; risk difference 11·0 (95 per cent c.i. 0·3 to 21·2) per cent). Skin irritation rates were high (78·2 versus 72·2 per cent), but did not differ significantly between the groups (risk difference 6·1 (95 per cent c.i. –3·2 to 15·10) per cent). There were no significant differences in quality of life or costs between the groups. Conclusion Intracutaneous suturing of an ileostomy is associated with more peristomal leakage than transcutaneous suturing. Overall stoma‐related complications did not differ between the two techniques. Registration number: NTR2369 (
http://www.trialregister.nl). More leaks with intracutaneous
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Affiliation(s)
- M F Sier
- Department of Surgery, University Medical Centre Leiden, Leiden, The Netherlands
| | - D D Wisselink
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - R J Oostenbroek
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - G J Veldink
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - B Lamme
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | - Q A J Eijsbouts
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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Stomal construction: Technical tricks for difficult situations, prevention and treatment of post-operative complications. J Visc Surg 2018; 155:41-49. [DOI: 10.1016/j.jviscsurg.2017.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sier MF, Oostenbroek RJ, Dijkgraaf MGW, Veldink GJ, Bemelman WA, Pronk A, Spillenaar-Bilgen EJ, Kelder W, Hoff C, Ubbink DT. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial. Colorectal Dis 2017; 19:739-749. [PMID: 28192627 DOI: 10.1111/codi.13630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/12/2016] [Indexed: 12/13/2022]
Abstract
AIM Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost. METHOD Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care. RESULTS The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P < 0.001). In the SP more patients required extra care at home for their ostomy than in the NP (60.6% vs 33.7%, respectively; risk difference 26.9%, 95% CI: 13.5-40.4%). Stoma revision was done more often in the SP (n = 11) than in the NP (n = 2). Total costs in the SP did not differ significantly from the NP. CONCLUSION The NP did not reduce the number of stoma-related complications but did lead to improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended.
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Affiliation(s)
- M F Sier
- Department of Surgery, University Medical Centre Leiden, Leiden, The Netherlands
| | - R J Oostenbroek
- Department of Surgery, Albert Schweitzer Hospital Dordrecht, Dordrecht, The Netherlands
| | - M G W Dijkgraaf
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - G J Veldink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessen Hospital Utrecht, Utrecht, The Netherlands
| | | | - W Kelder
- Department of Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - C Hoff
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - D T Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Belkin N, Bordeianou LG, Shellito PC, Hawkins AT. Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection. Am Surg 2017. [DOI: 10.1177/000313481708300739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.
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Affiliation(s)
| | - Liliana G. Bordeianou
- Colorectal Surgery Program, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul C. Shellito
- Colorectal Surgery Program, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexander T. Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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Abstract
When created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Conversely, when a patient develops complications related to their stoma, the impact on physical and mental health can be profound. Unfortunately, significant morbidity is associated with stoma creation conveying high rates of both early and late-term complications. Early complications include stomal ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess. Late complications include parastomal hernia, prolapse, retraction, and varices. This review will discuss commonly occurring nondermatological stoma complications and detail management strategies for the ostomate and the surgeon.
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Affiliation(s)
- Devi Mukkai Krishnamurty
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jeffrey Blatnik
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Matthew Mutch
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Kuizenga-Wessel S, Koppen IJN, Zwager LW, Di Lorenzo C, de Jong JR, Benninga MA. Surgical management of children with intractable functional constipation; experience of a single tertiary children's hospital. Neurogastroenterol Motil 2017; 29. [PMID: 27957788 DOI: 10.1111/nmo.13005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/06/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Children with intractable functional constipation (FC) may eventually require surgery. However, guidelines regarding the surgical management of children with intractable FC are lacking. The aim of this study was to describe the surgical management of FC in children. METHODS A retrospective chart review was performed of children with FC (according to the Rome III criteria) who underwent ileostomy, colostomy or (sub)total colectomy at a tertiary hospital. Treatment success was defined as no longer fulfilling the Rome III-FC-criteria or having a functional ostomy. In addition, a self-developed questionnaire was administered to parents by telephone to assess postsurgical satisfaction (yes-no question and rated on a scale of 1-10). KEY RESULTS Thirty-seven patients (68% female) were included; median age at first surgery was 12 years (range 1.6-17.6). The initial surgical procedure consisted of ileostomy (n=21), colostomy (n=10), sigmoid resection (n=5) and subtotal colectomy (n=1). Success criteria were fulfilled by 85% of the patients. Postsurgical satisfaction of parents was 91% with a median postoperative satisfaction score of 8 (range 2-10), and 97% would opt for the same procedure(s) if necessary. Thirty patients (81%) experienced stoma problems, with 12 patients (32%) requiring stoma-revisions. Other complications occurred in 16 patients (43%). CONCLUSIONS & INFERENCES Surgery can improve symptoms in children with intractable FC. Despite morbidity and complications, parental satisfaction is high. Prospective, high-quality research is necessary to develop guidelines for the diagnostic work-up and surgical management in children with intractable FC.
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Affiliation(s)
- S Kuizenga-Wessel
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - I J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - L W Zwager
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - C Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - J R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
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Ito E, Kosaka M, Kawaguchi C, Yoshida M, Ohdaira H, Nakashima K, Suzuki N, Imakita T, Tsutsui N, Kitajima M, Suzuki Y. Stomaplasty with pannicuectomy in an obese patient with stomal retraction: A case report. Int J Surg Case Rep 2016; 28:9-14. [PMID: 27657823 PMCID: PMC5035330 DOI: 10.1016/j.ijscr.2016.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/22/2016] [Accepted: 05/22/2016] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Stomal retraction is a common complication following stoma formation. A repeat surgical procedure for stomal revision is an invasive treatment that is often required as a result. CASE PRESENTATION An 81-year-old woman with obstructive rectal carcinoma and perforative peritonitis underwent an emergent anterior resection and colostomy (Hartmann's operation). After the operation, the patient changed the stoma pouch every day because of stomal retraction and leakage. Thirty-eight days after the operation, we performed a stomaplasty with pannicuectomy. Following this procedure, the patient changed the stoma pouch twice weekly. DISCUSSION Stomal retraction is caused by the thick subcutaneous fat and abnormal skin folds in obese patients, as well as the excess tension that is the result of inadequate mobilization. Treatment of stomal retraction typically requires an intraperitoneal stoma revision. Our method of panniculectomy with skin excision but without stomal revision does not involve an incision around the stoma and there is no risk of fecal contamination. CONCLUSION We report a case of an obese patient who underwent stomaplasty with pannicuectomy for stomal retraction. We believe that stomaplasty with pannicuectomy is a feasible option in obese patients with stomal retraction.
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Affiliation(s)
- Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Masaaki Kosaka
- Plastic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Chie Kawaguchi
- Plastic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Tomonori Imakita
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Nobuhiro Tsutsui
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Masaki Kitajima
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan.
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The Reversal of Stoma Following Open Abdomen Management. Indian J Surg 2015; 78:182-6. [PMID: 27358511 DOI: 10.1007/s12262-015-1336-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.
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Sarkut P, Dundar HZ, Tirnova I, Ozturk E, Yilmazlar T. Is stoma care effective in terms of morbidity in complicated ileostomies? Int J Gen Med 2015; 8:243-6. [PMID: 26316798 PMCID: PMC4547692 DOI: 10.2147/ijgm.s79224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Performing transient or permanent ileostomy is one of the common procedures involved in colorectal surgery. Complication rates up to 40% have been reported in ileostomies. In this report, the effect of specific stoma care unit on ileostomy and its complications were investigated. METHODS A total of 141 patients, who were operated and underwent ileostomy, due to different causes, at Department of General Surgery, Uludağ University, Bursa, Turkey, between 2003 and 2006, were examined, retrospectively. Patient records were examined in terms of age, sex, surgery indications, urgent/elective state, benign/malign origin, ileostomy type, complications and stoma care, and education. χ(2) test was used to compare the categorical data. RESULTS Among the patients, 95 (67%) were male and 46 (33%) were female. The mean age was 47 years (17-67). Some of the subjects (49%) were operated urgently and some (51%) were under elective conditions. The ileostomy types used included the following: end ileostomy (43%), loop ileostomy (46%), and double-barrel ileostomy (11%). Permanent ileostomy was performed in 23 patients and transient ileostomy was performed in 118 patients. The patients were operated because of either benign (48%) or malign (52%) causes. Complications developed in 37 (26%) patients. The rate of development of complication was markedly higher in ileostomies performed under urgent conditions (61% vs 39%) (P<0.001). The complications included mucocutaneous separation (12 patients), maceration in the peristomal skin (ten patients), retraction (five patients), necrosis (three patients), prolapsus (three patients), and other metabolic complications (four patients). The complications were treated with care (68%) and surgical revision (32%). CONCLUSION The rate of ileostomy was found to be higher in the male patients compared to female patients. The risk of development of complications was found to be higher in ileostomies performed under urgent conditions. The most common complication observed was mucocutaneous separation. Ileostomy complications can be treated conservatively with professional care and education.
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Affiliation(s)
- Pinar Sarkut
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Halit Ziya Dundar
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Ismail Tirnova
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Ersin Ozturk
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
| | - Tuncay Yilmazlar
- Department of General Surgery, Faculty of Medicine, Uludağ University, Görükle, Turkey
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Abstract
Intestinal colostomy complications are common in patients after colostomy, seriously affecting postoperative quality of life. They not only cause difficulties to postoperative nursing and influence postoperative rehabilitation, but also increase the psychological and economic burden. Reducing the incidence of stoma complications and improving the quality of nursing care are of important significance for improving nursing satisfaction and quality of life. This review aims to elucidate the factors influencing complications after colostomy as well as the types, nursing measures and nursing mode for these complications.
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Abstract
The construction of an intestinal stoma is fraught with complications and should not be considered a trivial undertaking. Serious complications requiring immediate reoperations can occur, as can minor problems that will subject the patient to daily and nightly distress. Intestinal stomas undoubtedly will dramatically change lifestyles; patients will experience physiologic and psychologic detriment with stoma-related problems, however minor they may seem. Common complications include poor stoma siting, high output, skin irritation, ischemia, retraction, parastomal hernia (PH), and prolapse. Surgeons should be cognizant of these complications before, during, and after stoma creation, and adequate measures should be taken to avoid them. In this review, the authors highlight these often seen problems and discuss management and prevention strategies.
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Affiliation(s)
- Michael Kwiatt
- Division of Colon and Rectal Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Michitaka Kawata
- Division of Colon and Rectal Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, New Jersey
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de Miguel Velasco M, Jiménez Escovar F, Parajó Calvo A. Estado actual de la prevención y tratamiento de las complicaciones de los estomas. Revisión de conjunto. Cir Esp 2014; 92:149-56. [DOI: 10.1016/j.ciresp.2013.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/14/2013] [Accepted: 09/15/2013] [Indexed: 12/31/2022]
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