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 Low Anterior Resection of Rectal Cancer and Vaginal Specimen Extraction with Da Vinci Xi

2018 ◽  
Author(s):  
Tuğrul Çakır ◽  
Arif Aslaner
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Da Vinci ◽  
Loop Ileostomy ◽  
Colorectal Anastomosis ◽  
Operation Time ◽  
Da Vinci Xi ◽  
Specimen Extraction ◽  
First Case

Introduction: Novel robotic surgery systems (da Vinci Xi) are superior to classical open and laparoscopic techniques with its clear and three-dimensional view. We aimed to present the first case low anterior resection of rectal cancer and vaginal specimen extraction with Da Vinci Xi.Case: A 75-year-old female patient with rectum adenocarcinoma was undergone robotic-assisted low anterior resection (LAR) of the rectum, vaginal removal of the specimen, colorectal anastomosis and loop ileostomy. The operation time was 190 minutes. There were no postoperative complications. Pathological tumor stage was stage pT1N0 with negative proximal, distal and radial resection margins. The patient was discharged on the third postoperative day.Conclusion: Robot-assisted LAR, total mesorectal excision, vaginal removal of the specimen, colorectal anastomosis, and loop ileostomy can be performed easily and safely with Da Vinci Xi at early stage rectal cancer. And the vaginal extraction of the specimen avoids us from a traditional abdominal incision.

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 Dysfunctional loop ileostomy after low anterior resection for rectal cancer in the presence of Meckel’s diverticulum: a case report

2015 ◽  
Vol 9 (1) ◽  
Author(s):  
Konstadinos G. Spiridakis ◽  
Eleftherios E. Sfakianakis ◽  
Manthos E. Flamourakis ◽  
Margetousakis C. Theodoros ◽  
Efstathios K. Rahmanis ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Case Report ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Loop Ileostomy ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum

scholarly journals Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038930
Author(s):  
Felix J Hüttner ◽  
Pascal Probst ◽  
André Mihaljevic ◽  
Pietro Contin ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Loop Ileostomy ◽  
Pilot Trial ◽  
Ileostomy Closure ◽  
Ghost Ileostomy ◽  
Anterior Rectal Resection ◽  
Randomised Controlled

IntroductionAnastomotic leakage is the most important complication in colorectal surgery occurring in up to 20% after low anterior rectal resection. Therefore, a diverting ileostomy is usually created during low anterior resection to protect the anastomosis or rather to diminish the consequences in case of anastomotic leakage. The so-called virtual or ghost ileostomy is a pre-stage ostomy that can be easily exteriorised, if anastomotic leakage is suspected, in order to avoid the severe consequences of anastomotic leakage. On the other hand, an actual ileostomy can be avoided in patients, who do not develop anastomotic leakage.Methods and analysisThe GHOST trial is a randomised controlled pilot trial comparing ghost ileostomy with conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision for rectal cancer. After screening for eligibility and obtaining informed consent, a total of 60 adult patients are included in the trial. Patients are intraoperatively randomised to the trial groups in a 1:1 ratio after assuring that none of the intraoperative exclusion criteria are present. The main outcome parameter is the comprehensive complication index as a measure of safety. Further outcomes include specific complications, stoma-related complications, complications of ileostomy closure, frequency of transformation of ghost ileostomy into conventional ileostomy, frequency of terminal ostomy creation, proportion of patients with an ostomy at 6 months after index surgery, anorectal function (Wexner score) and quality of life assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Follow-up for each individual patient will be 6 months.Ethics and disseminationThe GHOST trial has been approved by the Medical Ethics Committee of Heidelberg University (reference number S-694/2017). If the intervention proves to be safe, loop ileostomy could be spared in a large proportion of patients, thus also avoiding stoma-related complications and a second operation (ileostomy closure) with its inherent complications in these patients.Trial registration numberGerman Clinical Trials Registry (DRKS00013997); Universal Trial Number: U1111-1208-9742.

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