Impact of ileostomy in the adjuvant treatment and outcome of colon cancer

Impact of Ahmadi Continuing Nursing Model on self-care ability, stoma complications and quality of life of colostomy patients

OBJECTIVE

To analyze the effects of Ahmadi Continuing Nursing Model (ACNM) on the self-care ability, stoma complications and life quality in colostomy patients.

METHODS

The clinical data of 120 patients who underwent postoperative colostomy in our hospital from June 2020 to June 2023 were retrospectively analyzed. The patients were divided into control group (n = 60, treated with routine nursing) and observation group (n = 60, treated with the ACNM on the basis of routine nursing) according to different nursing methods. Postoperative recovery of gastrointestinal function, ostomy adaptability, self-care ability, and life quality before and after nursing were compared. The probability of complications before and after nursing was recorded between the two groups.

RESULTS

The time of first exhaust was 3.65 ± 0.82 d, the time of first meal was 1.83 ± 0.65 d, and the first bowel sound recovery was 1.47 ± 0.53 d in the observation group, which were shorter than those in the control group (4.38 ± 1.20 d, 3.12 ± 1.15 d, 2.39 ± 1.06 d, P < 0.001). After intervention, the positive emotions in the ostomy adaptation score were 32.09 ± 5.03 points, negative emotions were 31.41 ± 5.70 points, social life adaptation were 27.12 ± 4.98 points, and the total score was 90.78 ± 5.98 points in the observation group, which were significantly higher than those in the control group (26.32 ± 4.52 points, 24.25 ± 6.02 points, 20.25 ± 4.02 points, 67.25 ± 6.09 points, P < 0.001). The self-willingness was 34.18 ± 4.02 points, self-care skill was 10.57 ± 2.23 points, self-care knowledge was 18.59 ± 3.10 points, and the total score was 63.18 ± 4.98 points in the observation group, which were significantly higher than those in the control group (25.25 ± 3.08 points, 8.72 ± 2.13 points, 15.26 ± 2.70 points, 45.69 ± 4.09 points, P < 0.001). The physical function was 79.74 ± 2.81 points, psychological function was 76.71 ± 3.05 points, social function was 78.11 ± 3.50 points, and material life status was 60.06 ± 2.98 points in the quality of life in the observation group, which were significantly higher than those in the control group (75.36 ± 2.68 points, 69.72 ± 2.93 points, 72.33 ± 3.42 points, 51.23 ± 3.08 points, P < 0.001).

CONCLUSION

ACNM effectively promoted the recovery of gastrointestinal function after surgery in colostomy patients by improving patients' stoma adaptability, self-care ability and life quality and reducing the occurrence of complications, which was worthy of promotion.

Reducing dehydration-induced readmissions post-colorectal surgery: the impact of a prevention bundle

INTRODUCTION

Ileostomy, frequently created after colorectal resections, hinders the physiologic function of the colon and can lead to dehydration and acute kidney injury due to high stoma outputs. This study aimed to evaluate the effectiveness of preventive measures on ileostomy-induced dehydration and related readmissions in a high-volume unit.

METHODS

In this prospective cohort study at a high-volume colorectal surgery department in Turkiye, the Prospective Ileostomy-induced Dehydration Prevention Bundle Project (PIDBP) was assessed from March 2021 to March 2022. The study enrolled patients undergoing colorectal surgery with ileostomy and involved comprehensive inpatient stoma care, education, and a structured post-discharge follow-up. The follow-up included the "Hydration follow-up scale" to monitor ileostomy output and related complications. The primary outcome was the readmission rate due to dehydration-related complications. The patients receiving the bundle intervention were compared with patients treated in the preceding year, focusing on the effectiveness of interventions such as dietary adjustments, fluid therapy, and pharmacological management.

RESULTS

In the study, 104 patients were analyzed, divided into 54 pre-bundle and 50 bundle group patients, with no significant differences in patient characteristics. While the overall readmission rate due to dehydration was 12.5%, a significant reduction in dehydration-related readmissions was observed in the bundle group compared to the pre-bundle group (2% vs. 22%, p = 0.002). Univariate analysis identified high stoma output (> 800 ml/24 h) (p < 0.001), chronic renal failure (CRF) (p = 0.01), postoperative ileus (p = 0.03), higher ASA status (p = 0.04), extended hospital stays (p = 0.03), and small bowel resections (especially in J-pouch patients) (p < 0.001) as significant predictors of readmission. Multivariate analysis revealed that the mean ileostomy output before discharge was the sole significant predictor of dehydration-related readmission (OR 1.01), with an optimal cutoff of 877.5 ml/day identified with an area under the curve (AUC) of 0.947, demonstrating high sensitivity (92.3%) and specificity (86.8%) in predicting readmission risk.

CONCLUSION

The Prospective Ileostomy-induced Dehydration Prevention Bundle Project significantly reduced readmission rates after colorectal surgery.

Feasibility and outcomes of robotic sphincter-preserving surgery for rectal cancer after neoadjuvant treatment in patients with preexisting colostomy

BACKGROUND

Diverting colostomy followed by neoadjuvant treatment is a treatment of choice for obstructive rectal cancer. Such patients may be treated via a robotic approach with several advantages over conventional laparoscopic surgery. Conversely, the existing stoma may interfere with the optimal trocar position and thus affect the quality of robotic surgery. Moreover, the console surgeon does not face the patient, which may endanger the stoma.

METHODS

Patients with rectal cancer who underwent sphincter-preserving surgery were retrospectively investigated using a robotic platform after neoadjuvant treatment at our hospital. Based on pretreatment stoma creation, patients were divided into the NS (those without a stoma) and S groups (patients with a stoma). Baseline characteristics, types of neoadjuvant treatment, short-term surgical outcomes, postoperative anorectal manometric data, and survival were compared between the groups.

RESULTS

The NS and S groups comprised 65 and 9 patients, respectively. Conversion to laparotomy was required in three patients in the NS group. The S group required a longer console time than the NS group (median: 367 vs. 253 min, respectively, p = 0.038); however, no difference was observed in the total operative time (p = 0.15) and blood loss (p = 0.70). Postoperative complication rates, anorectal function, and oncological outcomes were similar between the groups.

CONCLUSIONS

Although console time was longer in patients with a stoma, robotic surgery could be performed safely like in those without a stoma after neoadjuvant treatment.

Early diverting stoma closure is feasible and safe: results from a before-and-after study on the implementation of an early closure protocol at a tertiary referral center

BACKGROUND

Evidence on early closure (EC) of defunctioning stoma (DS) after colorectal surgery shows a favorable effect when patients are carefully selected. Therefore, a clinical pathway adapted to the implementation of an EC strategy was developed in our center. The aim of this study was to carry out a comparative analysis of time until DS closure and DS-related morbidity before and after the implementation of an EC protocol (ECP).

METHODS

This study is a before-and-after comparative analysis. Patients were divided into two cohorts according to the observational period: patients from the period before the ECP implementation (January 2015-December 2019) [Period 1] and those from the period after that (January 2020-December 2022) [Period 2]. All consecutive patients subjected to elective DS closure within both periods were eligible. Early closure was defined as the reversal within 30 days from DS creation. Patients excluded from EC or those not closed within 30 days since primary surgery were analyzed as late closure (LC). Baseline characteristics and DS-related morbidity were recorded.

RESULTS

A total of 145 patients were analyzed. Median time with DS was shorter in patients after ECP implementation [42 (21-193) days versus 233 (137-382) days, p < 0.001]. This reduction in time to closure did not impact the DS closure morbidity and resulted in less DS morbidity (68.8% versus 49.2%, p = 0.017) and fewer stoma nurse visits (p = 0.029).

CONCLUSIONS

The ECP was able to significantly reduce intervals to restoration of bowel continuity in patients with DS, which in turn resulted in a direct impact on the reduction of DS morbidity without negatively affecting DS closure morbidity.

Necrotising fasciitis secondary to a perforated hepatic flexure tumour - A case report

INTRODUCTION AND IMPORTANCE

Necrotising fasciitis caused by a perforated colon cancer is a very rare occurrence and can be very life threatening needing urgent intervention involving tissue salvage and oncological treatment. There is not enough evidence in the literature regarding management of the same. This case report highlights one such case along with management principles.

PRESENTING CASE

We present a 66 year old male with 3 weeks of a progressive right lower quadrant lump and constitutional symptoms. He had a computed tomography scan demonstrating a complex collection in the right anterior abdominal wall, containing multiple locules of gas and air fluid levels near an abnormally thickened hepatic flexure. He was taken for an urgent debridement followed by laparotomy which demonstrated extensive abdominal wall necrotising fasciitis secondary to a perforated hepatic flexure tumour invading into the duodenum. He was given a diverting ileostomy. He had a relook laparotomy the next day for a right hemicolectomy and part of the duodenum resected with a refashioned end ileostomy. He was subsequently managed on the ward for two weeks and then discharged home. He remains well and has been referred to medical oncology for adjuvant chemotherapy.

CLINICAL DISCUSSION

A two step surgical approach was key in this case, first step for source control and the second step focused on an oncological resection.

CONCLUSION

This case explains the importance of excluding malignant causes of necrotising fasciitis. Perforated cancers can manifest as necrotising fasciitis and management should include timely debridement as well as oncological principles.