scholarly journals Protocol for a multicentre, dual prospective and retrospective cohort study investigating timing of ileostomy closure after anterior resection for rectal cancer: The CLOSurE of Ileostomy Timing (CLOSE-IT) study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023305
Author(s):  
Peter G Vaughan-Shaw ◽  
Katherine Gash ◽  
Katie Adams ◽  
Abigail E Vallance ◽  
Sophie A Pilkington ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Linear Regression Analysis ◽  
Ileostomy Closure ◽  
Rectal Cancer Surgery ◽  
Multivariate Linear Regression Analysis ◽  
Low Anterior Resection Syndrome ◽  
Treatment Pathways ◽  
Study Results ◽  
Closure Of Ileostomy

IntroductionA defunctioning ileostomy is often formed during rectal cancer surgery to reduce the potentially fatal sequelae of anastomotic leak. Once the ileostomy is closed and bowel continuity restored, many patients can suffer poor bowel function, that is, low anterior resection syndrome (LARS). It has been suggested that delay to closure can increase incidence of LARS which is known to significantly reduce quality of life. Despite this, within the UK, time to closure of ileostomy is not subject to national targets within the National Health Service and delay to closure exceeds 18 months in one-third of patients. Clinical factors, surgeon and patient preference or service pressures may all impact time to closure, yet to date no study has investigated this. The aim of this UK-wide study is to assess time to ileostomy closure and identify reasons for delays.Methods and analysisA UK-wide multicentre prospective snapshot study, together with retrospective analysis of ileostomy closure through The Dukes’ Club Research Collaborative including patients undergoing ileostomy closure in a 3-month period (April to June 2018) and all patients who underwent anterior resection and ileostomy formation over a historical 12-month period (2015). Time to closure and incidence of ‘non-closure’ will be calculated. Units will be surveyed to determine local clinical and management protocols and barriers to timely closure. Multivariate linear regression analysis will be used to determine factors significantly associated with delay to ileostomy closure.Ethics and disseminationStudy approved by the South West-Exeter Research Ethics Committee and the Health Research Authority. Study results will be submitted for presentation at international conferences and for publication in peer-reviewed journals. Results will be presented to and discussed with the patient and public representatives and relevant national bodies to facilitate the development of consensus guidelines on optimum treatment pathways.

scholarly journals The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amal Rhemouga ◽  
Stefan Buettner ◽  
Wolf O. Bechstein ◽  
Guido Woeste ◽  
Teresa Schreckenbach
Keyword(s):  
Rectal Cancer ◽  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Loop Ileostomy ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

The impact of timing of stoma closure on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer

2021 ◽  
pp. 126-134
Author(s):  
Hemn Hussain Kaka Ali ◽  
Qalandar Hussein Abdulkarim ◽  
Karzan Seerwan ◽  
Barham M. M .Salih
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Closure Of Ileostomy ◽  
The Mean ◽  
The Impact

This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus.  A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.    

scholarly journals Quality of life after rectal cancer surgery (systematic review)

2021 ◽  
Vol 20 (1) ◽  
pp. 59-67
Author(s):  
A. B. Serebriy ◽  
E. A. Khomyakov ◽  
I. O. Nafedzov ◽  
O. Yu. Fomenko ◽  
E. G. Rybakov
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Life Quality ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Low Anterior Resection Syndrome

Aim: search for modifiable and unmodifiable risk factors affecting the quality of life of patients after rectal cancer surgery.Materials and methods: the literature search was done according to the keywords: quality of life, rectal cancer, low anterior resection syndrome. Twelve prospective randomized studies, 2 cohort studies, and 2 meta-analyses are included in the study. The quality of life was assessed in the analyzed studies by using questionnaires for cancer patients and updated questionnaires for colorectal cancer: EORTC QLQ-CR29, QLQ-C30, QLQ-CR38, BIQ.Results: the literary data on influence of gender, age, surgery, stoma, and chemoradiotherapy on life quality of patients after rectal cancer surgery was analyzed.Conclusion: the most significant factor affecting the life quality of patients with rectal cancer is a violation of the body image if it is necessary to form the stoma on the anterior abdominal wall. The manifestations of the low anterior resection syndrome and the urination problems are significant risk factors in the case of restoration of bowel continuity.

Low Anterior Resection Syndrome and Quality of Life After Sphincter-Sparing Rectal Cancer Surgery

2019 ◽  
Vol 62 (1) ◽  
pp. 14-20 ◽  
Author(s):  
Emil H.A. Pieniowski ◽  
Gabriella J. Palmer ◽  
Therese Juul ◽  
Pernilla Lagergren ◽  
Asif Johar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome

scholarly journals Development and evaluation of a Japanese prediction model for low anterior resection syndrome after rectal cancer surgery

2020 ◽  
Author(s):  
Masakatsu Paku ◽  
Norikatsu Miyoshi ◽  
Shiki Fujino ◽  
Tsuyoshi Hata ◽  
Takayuki Ogino ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Prediction Model ◽  
Predictive Model ◽  
Predictive Factors ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Rectal Cancer Surgery ◽  
Low Anterior Resection Syndrome ◽  
Learning Set ◽  
Validation Set

Abstract Background: Low anterior resection syndrome (LARS) is the most common complication after rectal cancer resection. We aimed to identify predictive factors for LARS and to construct and evaluate a predictive model for LARS.Methods: This retrospective study included patients with rectal cancer more than one year after laparoscopic or robotic-assisted surgery. A questionnaire was administered to evaluate the degree of LARS. Clinical characteristics were examined with univariate and multivariate logistic regressions to identify predictive factors for major LARS. The obtained data was divided into learning set and validation set. A predictive model for major LARS was constructed using the learning set, and predictive accuracy of the validation set was assessed.Results: We reviewed a total of 160 patients with rectal cancer and divided them into a learning set (n = 115) and a validation set (n = 45). Univariate and multivariate analyses in the learning set showed that male (odds ratio [OR]: 2.88, 95% confidence interval [95%CI]: 1.11-8.09, p = 0.03), age <75 years (OR: 5.87, 95%CI: 1.14-47.25, p = 0.03) and tumors located <8.5 cm from the AV (OR: 7.20, 95%CI: 2.86-19.49, p <0.01) were significantly related to major LARS. A prediction model based on the patients in learning set was well calibrated.Conclusions: We found that sex, age and tumor location were independent predictors of major LARS in Japanese patients that underwent rectal cancer surgery. Our predictive model for major LARS could aid medical staff in educating and treating patients with rectal cancer before and after surgery.

Improving the time to ileostomy closure following an anterior resection for rectal cancer in the UK

2021 ◽  
Author(s):  
I. Vogel ◽  
P.G. Vaughan‐Shaw ◽  
K. Gash ◽  
K.L. Withers ◽  
G. Carolan‐Rees ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Ileostomy Closure ◽  
The Uk
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