permanent stoma
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Author(s):  
William J. Lossius ◽  
Tore Stornes ◽  
Tor A. Myklebust ◽  
Birger H. Endreseth ◽  
Arne Wibe

Abstract Purpose While local excision by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) is an option for low-risk early rectal cancers, inaccuracies in preoperative staging may be revealed only upon histopathological evaluation of the resected specimen, demanding completion surgery (CS) by formal resection. The aim of this study was to evaluate the results of CS in a national cohort. Method This was a retrospective analysis of national registry data, identifying and comparing all Norwegian patients who, without prior radiochemotherapy, underwent local excision by TEM or TAMIS and subsequent CS, or a primary total mesorectal excision (pTME), for early rectal cancer during 2000–2017. Primary endpoints were 5-year overall and disease-free survival, 5-year local and distant recurrence, and the rate of R0 resection at completion surgery. The secondary endpoint was the rate of permanent stoma. Results Forty-nine patients received CS, and 1098 underwent pTME. There was no difference in overall survival (OR 0.73, 95% CI 0.27–2.01), disease-free survival (OR 0.72, 95% CI 0.32–1.63), local recurrence (OR 1.08, 95% CI 0.14–8.27) or distant recurrence (OR 0.67, 95% CI 0.21–2.18). In the CS group, 53% had a permanent stoma vs. 32% in the pTME group (P = 0.002); however, the difference was not significant when adjusted for age, sex, and tumor level (OR 2.17, 0.95–5.02). Conclusions Oncological results were similar in the two groups. However, there may be an increased risk for a permanent stoma in the CS group.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Bin Zhang ◽  
Guang-Zuan Zhuo ◽  
Ke Zhao ◽  
Yong Zhao ◽  
Dong-Wei Gao ◽  
...  

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Catherine R. Hanna ◽  
Sean M. O’Cathail ◽  
Janet S. Graham ◽  
Mark Saunders ◽  
Leslie Samuel ◽  
...  

Abstract Background Advances in multi-modality treatment of locally advanced rectal cancer (LARC) have resulted in low local recurrence rates, but around 30% of patients will still die from distant metastatic disease. In parallel, there is increasing recognition that with radiotherapy and systemic treatment, some patients achieve a complete response and may avoid surgical resection, including in many cases, the need for a permanent stoma. Extended neoadjuvant regimes have emerged to address these concerns. The inclusion of immunotherapy in the neoadjuvant setting has the potential to further enhance this strategy by priming the local immune microenvironment and engaging the systemic immune response. Methods PRIME-RT is a multi-centre, open label, phase II, randomised trial for patients with newly diagnosed LARC. Eligible patients will be randomised to receive either: short course radiotherapy (25 Gray in 5 fractions over one week) with concomitant durvalumab (1500 mg administered intravenously every 4 weeks), followed by FOLFOX (85 mg/m2 oxaliplatin, 350 mg folinic acid and 400 mg/m2 bolus 5-fluorouracil (5-FU) given on day 1 followed by 2400 mg/m2 5-FU infusion over 46–48 h, all administered intravenously every 2 weeks), and durvalumab, or long course chemoradiotherapy (50 Gray to primary tumour in 25 fractions over 5 weeks with concomitant oral capecitabine 825 mg/m2 twice per day on days of radiotherapy) with durvalumab followed by FOLFOX and durvalumab. The primary endpoint is complete response rate in each arm. Secondary endpoints include treatment compliance, toxicity, safety, overall recurrence, proportion of patients with a permanent stoma, and survival. The study is translationally rich with collection of bio-specimens prior to, during, and following treatment in order to understand the molecular and immunological factors underpinning treatment response. The trial opened and the first patient was recruited in January 2021. The main trial will recruit up to 42 patients with LARC and commence after completion of a safety run-in that will recruit at least six patients with LARC or metastatic disease. Discussion PRIME-RT will explore if adding immunotherapy to neoadjuvant radiotherapy and chemotherapy for patients with LARC can prime the tumour microenvironment to improve complete response rates and stoma free survival. Sequential biopsies are a key component within the trial design that will provide new knowledge on how the tumour microenvironment changes at different time-points in response to multi-modality treatment. This expectation is that the trial will provide information to test this treatment within a large phase clinical trial. Trial registration Clinicaltrials.gov NCT04621370 (Registered 9th Nov 2020) EudraCT number 2019-001471-36 (Registered 6th Nov 2020)


2021 ◽  
Author(s):  
Takuya Miura ◽  
Yoshiyuki Sakamoto ◽  
Hajime Morohashi ◽  
Akiko Suto ◽  
Shunsuke Kubota ◽  
...  

Abstract Background Determine whether robotic surgery is more effective than transanal and conventional laparoscopic surgery in preserving bowel and urinary function after total mesorectal excision (TME). Methods Of 79 lower rectal cancer patients who underwent function-preserving TME between 2016 and 2020, 64 patients consented to a prospective questionnaire-based functional observation study (52 responded). At six months post-resection or ileostomy closure, Wexner, low anterior resection syndrome (LARS), modified fecal incontinence quality of life, and international prostate symptom scores were used to evaluate bowel and urinary function, comparing robotic surgery (RTME) with transanal (taTME) or conventional laparoscopic surgery (LTME). Results RTME was performed in 35 patients (54.7%), taTME in 15 (23.4%), and LTME in 14 (21.9%). While preoperative bowel/urinary functions were similar in all three procedures, and the distance from the anal verge to tumor was almost the same, more hand-sewn anastomoses were performed and the anastomotic height from the anal verge was shorter in taTME than RTME. At 2 years post-resection, 8 patients (12.5%) had a permanent stoma; RTME showed a significantly lower rate of permanent stoma than taTME (2.9% vs 40%, p < 0.01). Despite no significant difference, all bowel function assessments were better in RTME than in taTME or LTME. Major LARS was observed in all taTME and LTME cases, but only 78.8% of RTME. No clear difference arose between RTME and taTME in urinary function; urinary dysfunction was more severe in LTME than RTME (36.4% vs 6.1%, p = 0.02). Conclusions In function-preserving TME for lower rectal cancer, robotic surgery was suggested to be more effective than transanal and conventional laparoscopic surgery in terms of bowel and urinary functions.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Riccardo Lemini ◽  
Iktej S. Jabbal ◽  
Krystof Stanek ◽  
Shalmali R. Borkar ◽  
Aaron C. Spaulding ◽  
...  

Abstract Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility. Methods Rectal cancer patients who underwent elective surgery between January 2015 and December 2018 were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients. Results Of 2630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, advanced age, having open surgery, residence in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p < 0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p < 0.001). Conclusions Patients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Having permanent stoma was higher in patients living in South West Florida, patients with Medicaid insurance, and in the uninsured. Additionally, the payer type significantly affected the length of stay.


2021 ◽  
Vol 9 (4) ◽  
pp. 342-342
Author(s):  
Chuangkun Li ◽  
Xiusen Qin ◽  
Zifeng Yang ◽  
Wentai Guo ◽  
Rongkang Huang ◽  
...  

2021 ◽  
Author(s):  
Riccardo Lemini ◽  
Iktej Singh Jabbal ◽  
Krystof Stanek ◽  
Shalmali R. Borkar ◽  
Aaron C. Spaulding ◽  
...  

Abstract Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility.MethodsRectal cancer patients were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic, and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients.ResultsOf 2,630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, residing in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p<0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p<0.001). ConclusionsPatients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Additionally, the payer type significantly affected the length of stay and odds of receiving a permanent stoma.


Author(s):  
Jennie Burch ◽  
Brigitte Collins

The stoma care chapter explores the formation of a temporary or permanent stoma and the main types of stoma. The two main types of faecal output stoma are the colostomy and ileostomy. The urostomy or ileal conduit is a urinary output stoma. The care required for people undergoing or living with a stoma is explored and includes preoperative and postoperative care. Stoma appliances and products are described. There is information provided on dietary and discharge home from the hospital and the nursing advice needed in these situations. There are descriptions of the common complications associated with stomas and how these can be addressed as well as longer-term issues, such as living with a stoma. Reversal of a stoma is included to describe considerations related to having the stoma surgically closed. Succinct descriptions related to stomas are detailed within this chapter for use in clinical practice by the nurse.


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