scholarly journals Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal

2021 ◽  
Author(s):  
Simon Lindner ◽  
Steffen Eitelbuss ◽  
Svetlana Hetjens ◽  
Joshua Gawlitza ◽  
Julia Hardt ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Methodological Quality ◽  
Colorectal Anastomosis ◽  
Digital Rectal Examination ◽  
Contrast Enema ◽  
Paired Data ◽  
Endoscopic Procedures ◽  
Rectal Examination ◽  
Ileostomy Reversal

Abstract Purpose No clear consensus exists on how to routinely assess the integrity of the colorectal anastomosis prior to ileostomy reversal. The objective of this study was to evaluate the accuracy of contrast enema, endoscopic procedures, and digital rectal examination in rectal cancer patients in this setting. Methods A systematic literature search was performed. Studies assessing at least one index test for which a 2 × 2 table was calculable were included. Hierarchical summary receiver operating characteristic curves were calculated and used for test comparison. Paired data were used where parameters could not be calculated. Methodological quality was assessed with the QUADAS-2 tool. Results Two prospective and 11 retrospective studies comprising 1903 patients were eligible for inclusion. Paired data analysis showed equal or better results for sensitivity and specificity of both endoscopic procedures and digital rectal examination compared to contrast enema. Subgroup analysis of contrast enema according to methodological quality revealed that studies with higher methodological quality reported poorer sensitivity for equal specificity and vice versa. No case was described where a contrast enema revealed an anastomotic leak that was overseen in digital rectal examination or endoscopic procedures. Conclusions Endoscopy and digital rectal examination appear to be the best diagnostic tests to assess the integrity of the colorectal anastomosis prior to ileostomy reversal. Accuracy measures of contrast enema are overestimated by studies with lower methodological quality. Synopsis of existing evidence and risk–benefit considerations justifies omission of contrast enema in favor of endoscopic and clinical assessment. Trial registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019107771

scholarly journals The Digital Divide: A Retrospective Survey of Digital Rectal Examinations during the Workup of Rectal Cancers

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 855
Author(s):  
Omar Farooq ◽  
Ameer Farooq ◽  
Sunita Ghosh ◽  
Raza Qadri ◽  
Tanner Steed ◽  
...  
Keyword(s):  
Primary Care ◽  
Rectal Cancer ◽  
Care Provider ◽  
Primary Care Provider ◽  
Demographic Data ◽  
Significant Proportion ◽  
Digital Rectal Examination ◽  
Patient Questionnaire ◽  
Rectal Examination ◽  
Rectal Cancers

Background: Digital rectal examination (DRE) is considered an important part of the physical examination. However, it is unclear how many patients have a DRE performed at the primary care level in the work-up of rectal cancer, and if the absence of a DRE causes a delay to consultation with a specialist. Methods: A retrospective patient questionnaire was sent to 1000 consecutive patients with stage II or stage III rectal cancer. The questionnaire asked patients to recall if they had a DRE performed by their general practitioner (GP) when they first presented with symptoms or a positive FIT test. Demographic data, staging data, and time to consultation with a specialist were also collected. Results: A thousand surveys were mailed out, and a total of 262 patients responded. Of the respondents, 46.2% did not recall undergoing a digital rectal examination by their primary care provider. Women were less likely to undergo a DRE than men (28.6% vs. 44.3%, p = 0.019). While there was a trend towards longer times to specialist consultation in patients who did not undergo a DRE (27.0 vs. 12.2 weeks), this was not statistically significant (p = 0.121). Conclusion: A significant proportion of patients who are FIT positive or have symptomatic rectal bleeding do not recall having a DRE by their primary care provider. Barriers may include lack of comfort with performing DRE or lack of time. Clearer guidelines and more support for GP’s may increase uptake of DRE.

scholarly journals Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal

2020 ◽  
Author(s):  
S. Lindner ◽  
K. von Rudno ◽  
J. Gawlitza ◽  
J. Hardt ◽  
F. Sandra-Petrescu ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Loop Ileostomy ◽  
Tertiary Care ◽  
Digital Rectal Examination ◽  
Flexible Endoscopy ◽  
Contrast Enema ◽  
Test Accuracy ◽  
Ileostomy Reversal ◽  
The Impact ◽  
Group 1

Abstract Purpose This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. Methods This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. Results Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. Conclusion Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.

scholarly journals A nomogram to predict risk factors of frequent defecation early after ileostomy reversal for rectal cancer patients

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Jiaxin Deng ◽  
Mingli Su ◽  
Jiancong Hu ◽  
Dezheng Lin ◽  
Juan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Cancer Patients ◽  
Ileostomy Reversal

scholarly journals The role of Hartmann’s procedure in the elective management of rectal cancer: results of a Brazilian cohort study

2021 ◽  
Vol 48 ◽  
Author(s):  
ANDERSON RECH LAZZARON ◽  
INGRID SILVEIRA ◽  
PAULINE SIMAS MACHADO ◽  
DANIEL C DAMIN
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Surgical Complications ◽  
Rectal Resection ◽  
Colorectal Anastomosis ◽  
Hartmann’S Procedure ◽  
Septic Complications ◽  
Elective Resection ◽  
Defunctioning Stoma ◽  
Hartmann's Procedure

ABSTRACT Background: although preservation of bowel continuity is a major goal in rectal cancer surgery, a colorectal anastomosis may be considered an unacceptably high-risk procedure, particularly for patients with multiple comorbidities. We aimed to assess rates of surgical complications in rectal cancer patients according to the type of procedure they had undergone. Materials and Methods: this cohort included all rectal cancer patients undergoing elective resection at a referral academic hospital over 16 years. There were three study groups according to the type of performed operation: (1) rectal resection with anastomosis without defunctioning stoma (DS); (2) rectal resection with anastomosis and DS; and (3) Hartmann’s procedure (HP). Postoperative complications and clinical outcomes were assessed. Results: four-hundred and two patients were studied. The 118 patients in group 3 were significantly older (>10 years), had higher Charlson Comorbidity Index scores, and more ASA class ≥3 than patients in the other two groups. Sixty-seven patients (16.7%) had Clavien-Dindo complications grade ≥ III, corresponding to an incidence of 11.8%, 20.9%, and 14.4% in groups 1, 2, and 3, respectively (p=0.10). Twenty-nine patients (7.2%) had major septic complications that required reoperation, with an incidence of 10.8%, 8.2% and 2.5% in groups 1, 2 and 3, respectively (p=0.048). Twenty-one percent of the group 2 patients did not undergo the stoma closure after a 24-month follow-up. Conclusion: HP was associated with a lower incidence of reoperation due to intra-abdominal septic complications. This procedure remains an option for patients in whom serious surgical complications are anticipated.

Digital rectal examination and transrectal ultrasonography in staging of rectal cancer

1994 ◽  
Vol 35 (3) ◽  
pp. 300-304
Author(s):  
Sören R. Rafaelsen ◽  
O. Kronborg ◽  
C. Fenger
Keyword(s):  
Rectal Cancer ◽  
Digital Rectal Examination ◽  
Transrectal Ultrasonography ◽  
Rectal Examination

Self-Normalized Detection of ANXA3 from Untreated Urine of Prostate Cancer Patients without Digital Rectal Examination

2017 ◽  
Vol 6 (17) ◽  
pp. 1700449 ◽  
Author(s):  
Minhong Jeun ◽  
Sungwook Park ◽  
Yongdeok Kim ◽  
Jaewon Choi ◽  
Sang Hoon Song ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Digital Rectal Examination ◽  
Rectal Examination
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