Quality of life in patients with a permanent stoma after rectal cancer surgery

Pelvic floor muscle training for the prevention and management of low anterior resection syndrome in patients with rectal cancer: An evidence-based summary

Objective

This study aims to summarize the best available evidence on the effectiveness of pelvic floor muscle training (PFMT) in preventing and managing low anterior resection syndrome (LARS) among patients with rectal cancer, with the goal of enhancing quality of care.

Methods

A systematic search was conducted across databases, including BMJ Best Practice, UpToDate, WHO, GIN, UK NICE, NGC, SIGN, RNAO, NCCN, JBI Library, Cochrane Library, CINAHL, Web of Science, Embase, OVID, PubMed, Chinese Wanfang, CNKI, SinoMed, and VIP, covering publications from inception through June 30, 2024. We targeted clinical decisions, guidelines, evidence summaries, expert consensus statements, systematic reviews, and randomized controlled trials related to PFMT for LARS in patients with rectal cancer. Two independent reviewers assessed the quality of the literature and extracted key findings.

Results

A total of 15 articles were included, yielding 21 pieces of evidence across six core areas: multidisciplinary management, bowel function risk screening and assessment, the purpose and target population for PFMT, pre-exercise instructions, exercise regimens, and exercise feedback.

Conclusions

The summarized 21 recommendations provide guidance for integrating PFMT into care plans for patients with rectal cancer and LARS. However, given that evidence originates from diverse clinical settings, considerations such as the local health care environment should be evaluated before implementation. Future research should focus on optimizing PFMT regimens to improve bowel function outcomes in patients with rectal cancer, refining exercise protocols, and gathering further data to enhance clinical application.

Systematic review registration

Registered with the Fudan University Centre for Evidence-Based Nursing, registration number ES20245385.

Factors influencing quality of life in patients with a colostomy due to rectal cancer: A retrospective cohort study with multivariate and subgroup analyses

The quality of life (QOL) of patients with rectal cancer who have undergone colostomy surgery is influenced by various demographic, clinical and socioeconomic factors. Understanding these factors is crucial for improving patient outcomes and guiding clinical interventions. The present study aimed to evaluate the factors associated with QOL in patients with a colostomy following rectal cancer treatment, utilizing multivariate and subgroup analyses to identify key predictors and assess the robustness of the findings. The study was performed as a retrospective cohort study involving 134 patients. Data were collected on demographic characteristics, clinical variables and QOL scores using the European Organization for Research and Treatment of Cancer QOL Questionnaire-Core 30. Univariate analyses were performed to explore associations between individual factors and QOL. Multivariate linear and logistic regression analyses were also conducted to identify independent predictors of QOL. In addition, subgroup analyses were carried out based on sex, time since stoma surgery and residence, and sensitivity analyses were conducted to assess the impact of different data processing methods on the results. Univariate analysis revealed significant associations of higher educational levels, certain occupations such as government officials and teachers, and higher per capita family income with higher QOL scores. Multivariate regression analysis confirmed that higher education (B=7.89, P=0.001), independent stoma self-care (B=9.45, P<0.001) and higher income (B=6.92, P=0.001) were strong independent predictors of improved QOL. Logistic regression revealed that patients with a university education or higher [odds ratio (OR)=0.38, P=0.045] and those with higher income (OR=0.36, P=0.027) were less likely to report a low QOL. Subgroup analysis highlighted the consistent impact of education and stoma self-care ability across different patient groups, with independent stoma care being the most important factor for both sexes and across all time frames post-surgery. Sensitivity analysis demonstrated that the QOL findings were robust across various methods of handling missing data, with no significant changes in outcomes. In summary, educational level, income and stoma self-care ability were found to be the key determinants of QOL in patients with a colostomy following rectal cancer treatment. These findings highlight the need for targeted interventions to improve self-care abilities and mitigate socioeconomic disparities in this patient population. The results of the study are robust across different analytical approaches, reinforcing the validity of the conclusions.

Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center

PURPOSE

Colorectal cancer (CRC) significantly impacts the quality of life (QoL) of survivors, yet detailed assessments of long-term QoL are sparse. This study evaluates QoL among CRC survivors, examining the influence of different treatments and patient characteristics on outcomes.

METHODS

We conducted a cross-sectional study at a tertiary cancer center in Portugal, enrolling CRC patients who underwent curative surgery from 2013 to 2022. QoL was assessed using the EORTC QLQ-C30 and QLQ-CR29 at 1-, 3-, 5-, and 10-year follow-up intervals. Subgroup analyses were performed based on tumor location, radiotherapy administration, chemotherapy administration, presence of a stoma, and time since treatment, with sociodemographic and clinical factors examined on univariate and multivariate analysis.

RESULTS

Of the 825 eligible patients, 324 were invited and 179 participated (response rate: 55.2%). Overall, patients reported high global QoL and functional scores with low symptom scores, comparable to those of the general population. However, rectal cancer survivors experienced poorer outcomes in role and social functioning, body image, and symptom management. Those receiving radiotherapy or chemotherapy reported more symptoms, with chemotherapy recipients showing lower functional scores. Patients with a stoma had significantly lower QoL across functional and symptom scales. Long-term survivors reported decreased physical functioning. Multivariate analysis identified female gender, open surgery, and chemotherapy as factors associated with reduced QoL.

CONCLUSION

This study highlights significant disparities in QoL outcomes between CRC survivors, with QoL influenced by gender, cancer location, radiotherapy or chemotherapy, stoma presence, and survivorship duration, underscoring the need for personalized support programs and tailored care plans.

Neoadjuvant Radiotherapy vs Up-Front Surgery for Resectable Locally Advanced Rectal Cancer

Importance

Guidelines for resectable locally advanced rectal cancer (LARC) advocate for neoadjuvant radiotherapy (NRT) followed by surgery as the standard approach. However, recent trials have reported no oncological benefits of NRT-based therapy for middle or lower rectal cancer, raising the question of whether NRT followed by surgery remains the optimal treatment approach for resectable LARC overall.

Objective

To compare the outcomes of NRT followed by surgery vs up-front surgery for resectable LARC.

Design, Setting, and Participants

This cohort study, using a target trial emulation framework with nationwide registries in Taiwan, included patients undergoing curative resection for resectable LARC (cT1-2N1-2, cT3Nany) between January 1, 2014, and December 31, 2017, with follow-up until December 31, 2020. Data were analyzed from January 1, 2024, to February 15, 2025.

Exposure

NRT.

Main Outcomes and Measures

The primary outcomes were overall survival (OS) and local recurrence (LR). The secondary outcome was intraoperative diverting stoma outcomes.

Results

A total of 4099 patients were analyzed, including 1436 patients undergoing NRT followed by surgery (median [IQR] age, 62.0 [53.0-71.0] years; 1036 [72.1%] male) and 2663 patients undergoing up-front surgery (median [IQR] age, 65.0 [56.0-74.0] years; 1626 [61.1%] male). NRT followed by surgery, compared with up-front surgery, was associated with higher 3-year OS rates (88.5% vs 85.2%; hazard ratio [HR], 0.74; 95% CI, 0.59-0.92) but higher permanent diverting stoma rates (20.6% vs 11.1%; relative risk [RR], 1.91; 95% CI, 1.62-2.25); LR rates were not significantly different (5.7% vs 6.6%; HR, 0.78; 95% CI, 0.55-1.11). Subgroup analysis revealed that compared with up-front surgery, NRT followed by surgery was associated with improved outcomes in middle or lower rectal cancer but not upper rectal cancer (OS: HR, 1.54; 95% CI, 0.82-2.90; LR: HR, 1.08; 95% CI, 0.23-5.00). NRT followed by surgery was associated with significantly increased risks of permanent diverting stomas across different tumor heights, particularly in upper rectal cancer (RR, 3.54; 95% CI, 1.44-8.69).

Conclusions and Relevance

In this cohort study of nationwide registries in Taiwan, NRT followed by surgery was associated with improved oncological outcomes for overall resectable LARC, with excessive diverting stoma nonreversal as the trade-off. However, the benefits of NRT were not observed for upper rectal cancer. These findings raise concerns about potential harm from NRT and advise caution when performing NRT for upper rectal cancer.

Rectus abdominis muscle atrophy, prophylactic mesh, and stoma placement: retrospective findings from a prospective multicenter trial

PURPOSE

The primary aim of this study was to investigate whether rectus abdominis muscle atrophy is associated with a lower risk of developing parastomal hernia. Secondary objectives were to assess whether the use of prophylactic mesh is a risk factor for rectus abdominis muscle atrophy and whether the position of the stoma within the rectus abdominis muscle affects the risk of parastomal hernia.

METHODS

This retrospective study analysed patients from a prospective, randomised, multicentre trial in which rectal cancer patients were randomised to stoma creation with or without prophylactic mesh. Computed tomography at 12 months was evaluated to identify parastomal hernia, rectus abdominis muscle atrophy and position of stoma in the rectus abdominis muscle.

RESULTS

Out of 149 patients, rectus abdominis muscle atrophy was observed in 9% and parastomal hernia in 42% of patients. There was no association between rectus abdominis muscle atrophy and parastomal hernia (p = 0.80; RR 1.07; CI 0.62-1.86), nor between prophylactic mesh and rectus abdominis muscle atrophy (p = 0.19; RR 2.00; CI 0.7-5.73). Stoma placement within the rectus abdominis muscle also showed no association with parastomal hernia development (p = 0.69; RR 0.97; CI 0.81-1.15).

CONCLUSION

This study found no statistically significant association between rectus abdominis muscle atrophy and parastomal hernia. The use of prophylactic mesh was not a risk factor for rectus abdominis muscle atrophy, and stoma placement within the rectus abdominis muscle was not associated with parastomal hernia. The previously reported association between prophylactic mesh, rectus abdominis muscle atrophy, and parastomal hernia was not confirmed in this cohort.

The Potential Health Economic Value of Adding Magnetomotive Ultrasound to Current Diagnostic Methods for Detecting Lymph Node Metastases in Rectal Cancer

BACKGROUND

Local resection of early rectal cancer (RC) is a desirable treatment option compared with surgery, offering reduced morbidity, mortality, health care costs and avoidance of stoma. However, local resection is restricted to cases without suspicion of lymph node metastases (LNM). Current methods to diagnose LNM and risk estimations based on histopathology cannot reliably identify patients eligible for local resection. The NanoEcho diagnostic system is based on a novel method for lymph node staging in RC. The aim of this study was to perform a health economic analysis at an early stage of clinical development to estimate the potential value of adding NanoEcho diagnostics to current diagnostic methods in RC.

METHODS

A Markov model for RC diagnosis was developed where the costs and health outcomes, including quality-adjusted life years (QALYs), for adding the NanoEcho diagnostics to current diagnostic methods were compared with current diagnostic methods alone. The diagnostic performance of the NanoEcho diagnostic system is still unknown and the base-case analysis was performed at an assumed 85% sensitivity and 85% specificity. Two testing strategies corresponding to two alternative ways of implementing the diagnostic test in clinic were evaluated: (1) examine all patients diagnosed with RC and (2) examine only patients diagnosed with clinical stages T1 and T2.

RESULTS

Adding the NanoEcho diagnostic system resulted in a gain of 0.032 life years and 0.124 QALYs per patient in the target population compared with current diagnostic methods alone. At a cost-neutral level, the estimated justifiable price of NanoEcho diagnostics was SEK 6995 in the first testing strategy and SEK 50,658 in the second testing strategy. The justifiable price of the NanoEcho diagnostics at a willingness to pay of 500,000 SEK/QALY was SEK 10,654 in the first testing strategy and SEK 65,132 in the second testing strategy.

CONCLUSION

The results indicate that adding NanoEcho diagnostics to standard of care can potentially reduce healthcare costs and increase quality of life in RC patients, assuming a sensitivity and specificity of 85%.

Predictive Risk Factors for Low Anterior Resection Syndrome (LARS) in Rectal Cancer-An Observational Cohort Study

Background/Objectives: The improved long-term survival of rectal cancer patients has led to a major increase in the prevalence of functional complications. Understanding which patients are prone to develop major LARS is important for their preoperative counselling and follow-up. Herein, we aimed to assess the risk factors for LARS. Methods: This is a retrospective cohort study on rectal cancer patients. All patient and tumour variables, management plan, type of neoadjuvant therapy, radiation dose to anal sphincter, and perioperative outcomes were collected from the hospital electronic databases. We quantified LARS and compared the score before and after surgery (mean follow-up of 42.2 ± 32 months). Results: A total of 182 patients were included for the final analysis. LARS was present in 43.4% (n = 79) of patients, with 14.8% (n = 27) having minor LARS and 28.5% (n = 52) having major LARS. Age (p = 0.03), male gender (p < 0.00001), smoking (p = 0.04), neoadjuvant radiotherapy (p = 0.02), rectal stump length (p = 0.008), end-to-end anastomosis (p = 0.008), and ileostomy (p = 0.002) were found to significantly increase the rate of LARS. A logistic regression model based on the above variables was able to predict major LARS with good predictive value (AUC 0.700). Conclusions: LARS is highly common after sphincter-preserving surgery, and it is significantly more common in young, male patients with a history of smoking, having mid-lower rectal cancers with neoadjuvant radiotherapy, and undergoing TME surgery with end-to-end low anastomosis and ileostomy.

Impact of FOCUS-PDCA on reducing the incidence of complications after transradial intervention

BACKGROUND

The aim of this study was to evaluate the effect of the find, organize, clarify, understand, select-plan, do, check, act (FOCUS-PDCA) procedure on reducing the incidence of complications at the puncture site.

METHODS

Patients who underwent the transradial interventional therapy (TRI) were divided into control (N.=160) and FOCUS-PDCA (N.=158) groups. The postoperative complications at the puncture site was observed in the two groups, and the pain, bleeding, swelling and comfort of the two groups were compared and analyzed.

RESULTS

Two hours after surgery, the number of pain-free patients in the observation group was significantly higher than that in the control group (62.1% vs. 44.4%, P=0.014). The degree of swelling at 6 and 2 hours after TRI in observation group was significantly lower than that in control group (-0.08±0.23 vs. -0.00±0.17, P=0.001). No early radial artery occlusion was found in either group. The postoperative comfort score in observation group was significantly higher than that in control group (101.94±9.99 vs. 91.14±14.50, P<0.001).

CONCLUSIONS

The FOCUS-PDCA approach may reduce the incidence of early pain and long-term swelling after TRI, improve patient comfort, and enhance the quality of specialist care. The results suggested that FOCUS-PDCA had the value of popularization and application.

Parastomal Hernia: direct repair versus relocation: is stoma relocation worth the risk? A comparative meta-analysis and systematic review

Parastomal hernia is a prevalent and challenging complication in patients with stomas, frequently necessitating surgical intervention. The two primary approaches to parastomal hernia repair- direct repair without relocation and stoma relocation- offer distinct benefits and drawbacks. This systematic review and meta-analysis aimed to compare the efficacy and safety of stoma relocation versus direct repair in managing parastomal hernia. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies involving adult patients (≥ 18 years) with parastomal hernia who underwent either stoma relocation or direct repair, with a focus on clinically relevant outcomes. A comprehensive search of Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted up to September 2024. Key short-term outcomes (operative time, surgical site infection, urinary tract infection, bowel obstruction, length of hospital stay, and overall complications) and long-term outcomes (re-admission, recurrence, re-operation, and mortality) were extracted. Statistical analysis included risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Six studies were included, encompassing both laparoscopic and open-surgical techniques. Direct repair was associated with a significantly shorter operative time (MD: 115 min, 95% CI: 95.71 to 134, P < 0.00001) and a reduced length of hospital stay (MD: 2 days, 95% CI: 0.40 to 3.9, P = 0.02). While reoperation rates were significantly lower in the relocation group (RR: 0.15, 95% CI: 0.03 to 0.62, P = 0.009), other outcomes-including recurrence, re-admission, and overall complication rates-showed comparable results between the two approaches. Notably, there were no significant differences in surgical site infection, urinary tract infection, bowel obstruction, or mortality rates. Direct repair may be advantageous for reducing operative time and hospital stay, whereas stoma relocation appears beneficial in reducing reoperation rates. Future research should focus on developing standardized techniques and incorporating patient-specific factors to inform optimal surgical decision-making in parastomal hernia repair.

Minimally Invasive Rectal Surgery: Current Status and Future Perspectives in the Era of Digital Surgery

Over the past two decades, minimally invasive approaches in rectal surgery have changed the landscape of surgical interventions, impacting both malignant and benign pathologies. The dynamic nature of rectal cancer treatment owes much to innovations in surgical techniques, reflected in the expanding literature on available treatment modalities. Local excision, facilitated by minimally invasive surgery, offers curative potential for patients with early T1 rectal cancers and favorable pathologic features. For more complex cases, laparoscopic and robotic surgery have demonstrated significant efficacy and provided precise, durable outcomes while reducing perioperative morbidity and enhancing postoperative recovery. Additionally, advancements in imaging, surgical instrumentation, and enhanced recovery protocols have further optimized patient care. The integration of multidisciplinary care has also emerged as a cornerstone of treatment, emphasizing collaboration among surgeons, oncologists, and radiologists to deliver personalized, evidence-based care. This narrative review aims to elucidate current minimally invasive surgical techniques and approaches for rectal pathologies, spanning benign and malignant conditions, while also exploring future directions in the field, including the potential role of artificial intelligence and next-generation robotic platforms.

A cross-sectional observational study of quality of life in adult short bowel syndrome patients: What role does autologous gut reconstruction play?

BACKGROUND

Intestinal failure (IF) describes a condition of insufficient absorption capacity and general function of the gastrointestinal tract and may necessitate long-term intravenous fluid and nutrient supplementation. Quality of life (QoL) may be reduced in these patients. The aim of the study was to analyze QoL by two tools (SBS-QoL and SF-12) to elucidate which parameters impact QoL in patients with IF.

METHODS

QoL was assessed in a cohort of 105 patients with IF at a tertiary referral center for intestinal rehabilitation. Complete data for SBS-QoL and SF-12 were available in 44 of 81 surviving patients at a single time point for a cross-sectional analysis. Medical data, outcome parameters, and comorbidities (Charlson comorbidity index [CCI]) were extracted and entered in a prospective database for analysis and correlation with QoL assessment.

RESULTS

Subscales of SBS-QoL and SF-12 highly correlated with each other (P = -0.64 for physical subscales; P = -0.75 for mental subscales). Significant differences in QoL were detected in patients with Messing Type I (end-jejunostomy) and Type III anatomy (ileocolonic anastomosis) (one-way ANOVA: P < 0.05). Performance of autologous gut reconstruction (AGR) was associated with significantly better physical QoL. CCI correlated significantly with QoL scores. Longer duration of illness resulted in higher QoL in SBS-QoL (reduction of 0.15 per month; P = 0.045).

CONCLUSION

Both SBS-QoL and SF-12 are useful to determine QoL in patients with IF. AGR was associated with improved QoL by changing SBS-related anatomy and function. Thus, AGR surgery should be included in the treatment plan whenever possible. Comorbidities should be addressed interdisciplinarily to improve QoL.

SELective defunctioning Stoma Approach in low anterior resection for rectal cancer (SELSA): Protocol for a prospective study with a nested randomized clinical trial investigating stoma-free survival without major LARS following total mesorectal excision

AIM

Accumulated data suggest that routine use of defunctioning stoma in low anterior resection for rectal cancer may cause kidney injury, bowel dysfunction and a higher risk of permanent stomas. We aim to study whether avoidance of a diverting stoma in selected patients is safe and reduces adverse consequences.

METHODS

SELSA is a multicentre international prospective observational study nesting an open-label randomized clinical trial. All patients with primary rectal cancer planned for low anterior resection are eligible. Patients operated with curative intent, aged <80 years, with an American Society of Anaesthesiologists' fitness grade I or II, and a low predicted risk of anastomotic leakage are eligible to 1:1 randomization between no defunctioning stoma (experimental arm) or a defunctioning stoma (control arm). The primary outcome is the composite measure of 2-year stoma-free survival without major low anterior resection syndrome (LARS). Secondary outcomes include anastomotic leakage, postoperative mortality, reinterventions, stoma-related complications, quality of life measures, LARS score, and permanent stoma rate. To be able to state superiority of any study arm regarding the main outcome, with 90% statistical power and assuming 25% attrition, we aim to enrol 212 patients. Patient inclusion will commence in the autumn of 2024.

CONCLUSION

The SELSA study is investigating a tailored approach to defunctioning stoma use in low anterior resection for rectal cancer in relation to the risk of anastomotic leakage. Our hypothesis is that long-term effects will favour the selective approach, enabling some patients to avoid a defunctioning stoma.

TRIAL REGISTRATION

Swedish Ethical Review Authority approval (2023-04347-01, 2024-02418-02 and 2024-03622-02), Regional Ethics Committee Denmark (H-24014463), and ClinicalTrials.gov (NCT06214988).

Stoma Acceptance Mediates Body Image Distress and Mental Health-Related Quality of Life: A Single-Center Study on Radical Cystectomy Patients with Ureterostomy

Background: Muscle-invasive bladder cancer and subsequent radical cystectomy with ureterocutaneostomy significantly impact patients' body image and quality of life, potentially increasing the risk of adverse mental health outcomes. Acceptance may represent a psychosocial resource to buffer the effects of body image impairment on health, thereby supporting stoma adjustment and preserving quality of life. Objective: This study aimed to investigate the mediating role of stoma acceptance in the relationship between body image distress and mental health. Methods: A single-center cross-sectional survey was conducted with 73 muscle-invasive bladder cancer patients undergoing radical cystectomy with ureterocutaneostomy. Participants completed structured, anonymous self-report measures assessing body image distress, stoma acceptance, and mental health-related quality of life through validated questionnaires. Results: Statistical analyses revealed significant negative correlations between body image distress and mental health and stoma acceptance. Conversely, stoma acceptance was significantly and positively associated with mental health. Regression-based mediation modeling indicated that stoma acceptance exerted a significant mediating effect on the relationship between body image and mental health-related quality of life. Conclusions: These findings highlight the considerable and unprecedented role of stoma acceptance as a mediating factor that may promote the adjustment and enhance the quality of life of urostomy patients. Further research is warranted to explore interventions targeting stoma acceptance to prevent body image distress and promote mental health.

Systematic review and meta-analysis comparing outcomes of multi-port versus single-incision laparoscopic surgery (SILS) in Hartmann's reversal

BACKGROUND

Colostomy formation as part of the Hartmann's procedure is often performed during emergency surgery as a damage limitation measure where attempts at bowel anastomosis and continuity are contraindicated. Hartmann's reversal (HR) remains challenging and can be attempted through open surgery and various minimally invasive techniques (laparoscopic and robotic platforms). We aimed to analyse outcomes of conventional multi-port laparoscopy (CL) versus single-incision approach (SILS) in patients undergoing HR.

METHODS

A comprehensive online search of various databases was conducted in accordance with PRISMA guidelines including Medline, PubMed, Embase, and Cochrane. Comparative studies of patients undergoing CL and SILS for HR were included. Analysed primary outcomes were total operative time and mortality rate. Secondary outcomes included post-operative complications, length of hospital stay, risk of visceral injury intra-operatively, and re-operation rate. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale (NOS) was used to assess bias.

RESULTS

Two observational studies matching our inclusion criteria with a total of 160 patients (SILS 100 vs. CL 60) were included. Statistical difference was observed for one outcome measure: operative duration (MD - 44.79 CI - 65.54- - 24.04, P < 0.0001). No significant difference was seen in mortality rate (OR 1.66 CI 0.17-16.39, P = 0.66), overall post-operative complications (OR 0.60 CI 0.28-1.32, P = 0.20), length of stay (MD - 0.22 CI - 4.25-3.82, P = 0.92), Clavien-Dindo III + complications (OR 0.61 CI 0.15-2.53, P = 0.50), risk of visceral injury (OR 1.59 CI 0.30-8.31, P = 0.58), and re-operation rates (OR 0.73 CI 0.08-6.76, P = 0.78).

CONCLUSION

Accounting for study limitations, the SILS procedure seems to be quicker with non-inferior outcomes compared with the conventional multi-port approach. This may lead to better patient satisfaction and cosmesis and potentially reduce the risk of future incisional hernia occurrence. However, well-designed, randomised studies are needed to draw more robust conclusions and recommendations.

Outcomes of rectal cancer treatment in rural Australia and New Zealand: analysis of the bowel cancer outcomes registry

BACKGROUND

The demographics and geography of Australia and New Zealand (ANZ), with few metropolitan centres and vast, sparsely populated rural areas, represent a challenge to providing equal care to all patients. This study aimed to compare rectal cancer care at rural and urban hospitals in ANZ.

METHODS

From the Bowel Cancer Outcomes Registry (BCOR, formerly known as the Bi-National Colorectal Cancer Audit; BCCA), rectal cancer patients treated between 2007 and 2020 were compared based on hospital location (urban versus rural). Propensity-score matching was performed to correct for differences in baseline characteristics between groups.

RESULTS

A total of 9385 rectal cancer patients were identified from the BCOR: 1329 (14.2%) were treated at rural hospitals and 8056 (85.8%) at urban hospitals. Propensity-score matching resulted in 889 patients in each group, matched for age, ASA score, hospital type (public/private), tumour height from the anal verge, and pre-treatment cT- and cAJCC-stage. Rural patients had fewer pre-treatment MRIs (67.9% versus 74.7%; P = 0.002), and underwent less neoadjuvant therapy (44.7% versus 50.9%; P = 0.01). Rural patients underwent fewer ULARs (39.4% versus 45.6%; P = 0.03), and fewer anastomoses were formed (67.9% versus 74.4%; P = 0.05). CRM rates and postoperative AJCC stages (P = 0.19) were similar between groups (P = 0.87). Fewer rural patients received adjuvant chemotherapy (37.8% versus 43.3%; P = 0.02).

CONCLUSION

There are significant differences in pre-treatment MRI rates, (neo)adjuvant treatment rates and surgical procedures performed between rectal cancer patients treated at rural and urban hospitals in ANZ, while CRM rates and postoperative AJCC stages are similar.

Predictive factors associated with health-related quality of life in patients with colorectal cancer in Iran: a cross-sectional study

OBJECTIVES

This study aims to identify the primary factors influencing health-related quality of life (HRQoL) in patients with colorectal cancer (CRC), hypothesising that specific patient characteristics and clinical factors significantly impact HRQoL.

DESIGN

This was a cross-sectional study conducted over 1 month, from 1 April 2022 to 1 May 2022.

SETTING

The study was conducted in five hospitals in the northwest region of Iran, focusing on outpatient chemotherapy services.

PARTICIPANTS

A total of 251 patients diagnosed with colon and rectal cancer participated in the study. Inclusion criteria included a confirmed diagnosis by an oncologist, ability to communicate, willingness to participate and being aware of their diagnosis and treatment. Exclusion criteria were the presence of other chronic diseases, cognitive disorders, known mental disorders and unwillingness to participate.

INTERVENTIONS

No interventions were applied as this was an observational study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the HRQoL of patients with CRC, measured using a standardised SF-36 (36-Item Short Form Health Survey) questionnaire. Secondary outcomes included the impact of demographic and clinical factors on HRQoL.

RESULTS

The total score of HRQoL in these patients is 47.22±16.78, which indicates that HRQoL is disturbed in these patients. Also, the results of the stepwise multiple regression revealed that among all the participants' characteristics considered, seven factors: not having another disease besides cancer (p<0.001, β: 12.91, 95% CI 8.40, 17.42), only receiving chemotherapy (p<0.001, β: 9.10, 95% CI 4.12, 14.09), not having colostomy (p<0.001, β: 10.27, 95% Cl 5.70, 14.84), female sex (p=0.046, β: -4.52, 95% Cl -8.95, -0.08), living in their own house (p=0.001, β: 11.25, 95% Cl 4.77, 17.73), living in city (p=0.002, 17.74, 95% Cl 6.51, 28.96) and finally not having a job (p=0.003, β: -7.47, 95% Cl -12.31, -2.63), including are the factors that have the most predictive power in HRQoL.

CONCLUSIONS

The findings of this study encourage health service providers and planners to pay special attention to the characteristics of patients with CRC as identified in this study. Notably, several HRQoL scores in patients with CRC are low, and the study found that patient characteristics, such as the presence of colostomy, unemployment, female gender and comorbidities, significantly predict the overall HRQoL score. Future research should focus on interventional studies aimed at minimising the adverse effects of disease symptoms on HRQoL in these vulnerable patients.

Short-term outcomes after primary total mesorectal excision (TME) versus local excision followed by completion TME for early rectal cancer: population-based propensity-matched study

BACKGROUND

Colorectal cancer screening programmes have led to a shift towards early-stage colorectal cancer, which, in selected cases, can be treated using local excision. However, local excision followed by completion total mesorectal excision (two-stage approach) may be associated with less favourable outcomes than primary total mesorectal excision (one-stage approach). The aim of this population study was to determine the distribution of treatment strategies for early rectal cancer in the Netherlands and to compare the short-term outcomes of primary total mesorectal excision with those of local excision followed by completion total mesorectal excision.

METHODS

Short-term data for patients with cT1-2 N0xM0 rectal cancer who underwent local excision only, primary total mesorectal excision, or local excision followed by completion total mesorectal excision between 2012 and 2020 in the Netherlands were collected from the Dutch Colorectal Audit. Patients were categorized according to treatment groups and logistic regressions were performed after multiple imputation and propensity score matching. The primary outcome was the end-ostomy rate.

RESULTS

From 2015 to 2020, the proportion for the two-stage approach increased from 22.3% to 43.9%. After matching, 1062 patients were included. The end-ostomy rate was 16.8% for the primary total mesorectal excision group versus 29.6% for the local excision followed by completion total mesorectal excision group (P < 0.001). The primary total mesorectal excision group had a higher re-intervention rate than the local excision followed by completion total mesorectal excision group (16.7% versus 11.8%; P = 0.048). No differences were observed with regard to complications, conversion, diverting ostomies, radical resections, readmissions, and death.

CONCLUSION

This study shows that, over time, cT1-2 rectal cancer has increasingly been treated using the two-stage approach. However, local excision followed by completion total mesorectal excision seems to be associated with an elevated end-ostomy rate. It is important that clinicians and patients are aware of this risk during shared decision-making.

Quality of life in permanent ostomates - what really matters to them?

PURPOSE

The impact of a permanent stoma, such as post-abdominoperineal resection (APR), on quality of life (QoL) is well-documented. While stoma-related QoL tools exist, their relationship with stoma satisfaction is unclear. This study aimed to identify which aspects of QoL were most associated with stoma satisfaction.

METHODOLOGY

A cross-sectional study of consecutive patients who had an APR for rectal cancer at an Australian tertiary hospital (2012-2021), identified from a prospectively maintained database, was conducted. The Stoma-QoL questionnaire was used. Overall patient satisfaction with stoma function, and whether healthcare advice was sought for stoma dysfunction, were explored. Linear regression assessed the association between individual issues examined in the Stoma-QoL questionnaire and overall patient satisfaction with stoma function.

RESULTS

Overall, 64 patients (62.5% male, mean 68.1 years) participated. Stoma-QoL score was associated with stoma satisfaction (P < 0.05). QoL items impacting satisfaction were: needing to know nearest toilet location (P = 0.04), pouch smell concerns (P = 0.008), needing daytime rest (P = 0.02), clothing limitations (P = 0.02), sexual attractiveness concerns (P < 0.05), embarrassment (P < 0.05), difficulty hiding the pouch (P = 0.02), concerns about being burdensome (P = 0.04) and difficulty with interpersonal interaction (P = 0.03). Only 11 (17.2%) patients sought healthcare advice for stoma dysfunction.

CONCLUSION

While stoma-specific QoL is associated with stoma satisfaction, individual QoL aspects impact differently on satisfaction in permanent colostomy patients. These findings may help identify focus areas for peri-operative counselling for clinicians and stomal therapists, highlight the importance of tailored multidisciplinary care in ostomates and suggests that a stoma type-specific Stoma-QoL questionnaire is required.

Ostomy Care Nurses' Knowledge and Practice Related to Prevention and Management of Parastomal Hernias in Adults: A Nationwide Survey of UK Stoma Care Nurses

PURPOSE

The purpose of this study was to describe the knowledge and practices of ostomy care nurses related to the United Kingdom's Association of Stoma Care Nurses (ASCN) 2016 guidelines for prevention and management of parastomal hernia (PSH) in adults.

DESIGN

Cross-sectional descriptive study.

SUBJECTS AND SETTING

The target population was approximately 300 stoma care nurses; 120 useable responses to the survey were received, reflecting a response rate of approximately 40%.

METHODS

A 31-item questionnaire was developed for the purposes of this study, consisting of multiple choice and short answer questions grouped into 2 sections; demographics, and knowledge and practices. The questionnaire was distributed to members of the ASCN who work with adults via an online survey platform with the aim of reaching as many respondents as possible. The Chi-square test was used to determine relationships between the nominal demographic data and the nominal knowledge and practices data.

RESULTS

Almost two-thirds of respondents (65%, n = 78) rated their knowledge relating to prevention and management of PSH as good or excellent. Nevertheless, 79.8% (n = 95) indicated they needed additional education to improve their knowledge and practice related to prevention of PSH. Those who rated their knowledge as excellent or good were significantly more likely to be aware of the guidelines compared to those who ranked their knowledge as average or poor.

CONCLUSIONS

Study findings suggest variability in knowledge among UK stoma care nurses, along with a desire for additional education in this area of care.

Smooth Return to Work Through Early Rehabilitation and Interdisciplinary Collaboration After Ostomy: A Case Report of a Japanese Patient

A male patient in his 40s was diagnosed with rectal cancer and underwent abdominoperineal resection (APR) with permanent end colostomy as surgical treatment. He wanted to return to work as soon as possible after discharge. A physical therapist (PT) was involved in the preoperative consultation, and both the PT and occupational therapist started bed rest and activities of daily living (ADL) practice the day after surgery. On the third postoperative day, lightweight trunk exercises were initiated with a gradual increase in load. Stoma management was supervised by a nurse and progress was monitored. The patient's progress in ADLs, postoperative complications, and return to work were evaluated two weeks after discharge. Consequently, the patient was able to continue rehabilitation without early complications related to postoperative stoma. He could lift 20 kg and return to carpentry two weeks after discharge. The stoma quality of life improved from 61 points at two weeks after surgery to 74 points at two weeks after discharge. Early rehabilitation for social reintegration after ostomy creation can be safely performed under PT supervision, and a comprehensive interprofessional collaboration can contribute to smooth social reintegration.

Analysis of risk factors for the sigmoid stoma complications in patients after abdominoperineal resection surgery: An observational study

To analyze the risk factors for intraperitoneal sigmoid stoma complications after abdominoperineal resection (APR) surgery to guide clinical practice. Patients who were diagnosed with rectal cancer and underwent APR surgery from June 2013 to June 2021 were retrospectively enrolled. The characteristics of the stoma complication group and the no stoma complication group were compared, and univariate and multivariate logistic analyses were employed to identify risk factors for sigmoid stoma-related complications. A total of 379 patients who were diagnosed with rectal cancer and underwent APR surgery were enrolled in this study. The average age of the patients was 61.7 ± 12.1 years, and 226 (59.6%) patients were males. Patients in the short-term stoma complication group were younger (55.7 vs 62.0, P < .05) and had a more advanced tumor stage (P < .05). However, there was no significant difference between the long-term stoma complication group and the no stoma complication group. Multivariate logistic regression analysis revealed that operation time was an independent risk factor (P < .05, OR = 1.005, 95% CI = 1.000-1.010) for short-term stoma complications. Both the short-term and long-term stoma complication rates in our institution were low. A longer operation time was an independent risk factor for short-term stoma complications after APR surgery.

Clinical outcome and prognostic factors of T4N0M0 colon cancer after R0 resection: A retrospective study

BACKGROUND

Paradoxically, patients with T4N0M0 (stage II, no lymph node metastasis) colon cancer have a worse prognosis than those with T2N1-2M0 (stage III). However, no previous report has addressed this issue.

AIM

To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.

METHODS

Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021, of which 112 patients were assigned to the training cohort, and the remaining 88 patients were assigned to the validation cohort. Differences between the training and validation groups were analyzed. The training cohort was subjected to multivariate analysis to select prognostic risk factors for T4N0M0 colon cancer, followed by the construction of a nomogram model.

RESULTS

The 3-year overall survival (OS) rates were 86.2% and 74.4% for the training and validation cohorts, respectively. Enterostomy (P = 0.000), T stage (P = 0.001), right hemicolon (P = 0.025), irregular review (P = 0.040), and carbohydrate antigen 199 (CA199) (P = 0.011) were independent risk factors of OS in patients with T4N0M0 colon cancer. A nomogram model with good concordance and accuracy was constructed.

CONCLUSION

Enterostomy, T stage, right hemicolon, irregular review, and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer. The nomogram model exhibited good agreement and accuracy.

Impact of parastomal hernia on colostomy costs at 1 year: Secondary analysis of a randomized clinical trial (STOMAMESH)

BACKGROUND AND AIMS

Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care.The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH.

METHODS

Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery.

RESULTS

Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH.

CONCLUSIONS

PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.

From burden to relief: The economic and quality-of-life advantages of pseudo continent perineal colostomy in ultra-low rectal cancer patients

BACKGROUND AND OBJECTIVE

Pseudo Continent Perineal Colostomy (PCPC) is an alternative technique to left iliac colostomy (LIC) after abdominoperineal resection for ultra low rectal cancer (ULRC). It allows placing the stoma in the perineum to preserve patients' body image. However, concerns about its impact on quality of life and management costs have limited its adoption. We aimed to compare the early outcomes and financial burden of PCPC and LIC in ULRC patients in Morocco, a low-middle-income country.

METHODS

From January 2018 to December 2019, all patients who underwent abdomino-perineal resection (APR) with LIC or PCPC were prospectively enrolled. For each patient, baseline characteristics, and in hospital and 90 days morbidity with a focus on perineal complications were reported. Quality of life (QOL) was assessed using the validated EORTC-C30 and CR29 questionnaires. Financial burden to patients was reported using declarative out-of-pocket costs (OOPC) analysis.

RESULTS

Among 49 patients who underwent APR, 33 received PCPC and 16 received definitive LIC. Similar rates of early perineal complications were observed between the two groups (p = 0.49). Readmission rate at POD90 was higher in the LIC-group due to perineal sepsis (p = 0.09). QOL analysis at 6 months revealed that patients with PCPC had a higher global health status (p = 0.006), a better physical functioning and reported fewer symptoms of flatulence and fecal incontinence (p = 0.001). Patients with a LIC reported more financial difficulties with higher median OOPC of stoma management up to €23 versus €0 per month for PCPC (p = 0.0024). PCPC was the only predictive factor of improved patient reported outcomes.

CONCLUSIONS

PCPC is a cost-effective alternative to the standard definitive colostomy without alteration of the QOL or additional perineal complications during the first 6 months following the surgery. These findings may help convince surgeons to offer this option to patients refusing definitive LIC.

Management after non-curative endoscopic resection of T1 rectal cancer

Since the introduction of population-based screening, increasing numbers of T1 rectal cancers are detected and removed by local endoscopic resection. Patients can be cured with endoscopic resection alone, but there is a possibility of residual tumor cells remaining after the initial resection. These can be located intraluminally at the resection site or extraluminally in the form of (lymph node) metastases. To decrease the risk of residual cells progressing towards more advanced disease, additional treatment is usually needed. However, with the currently available risk stratification models, it remains challenging to determine who should and should not be further treated after non-curative endoscopic resection. In this review, the different management strategies for patients with non-curatively treated T1 rectal cancers are discussed, along with the available evidence for each strategy and relevant considerations for clinical decision making. Furthermore, we provide practical guidance on the management and surveillance following non-curative endoscopic resection of T1 rectal cancer.

Anal Cancers in Previously Screened Versus Unscreened Patients: Tumor Stage and Treatment Outcomes

BACKGROUND

Targeted screening programs for patients at high risk for anal squamous-cell carcinoma have been proposed; however, the evidence in support of screening remains unclear.

OBJECTIVE

This study aimed to determine whether screening high-risk patients (predominantly those living with HIV) detected squamous-cell carcinoma at an earlier stage compared to the routine practice of not screening.

DESIGN

This is a cohort study.

SETTINGS

This study was conducted at a quaternary care center in Canada.

PATIENTS

Included patients were at least 18 years old with a pathologic diagnosis of invasive anal squamous-cell carcinoma between 2002 and 2022.

INTERVENTIONS

Patients diagnosed through a high-risk screening program were compared to those who did not undergo screening.

MAIN OUTCOME MEASURES

The primary outcome was clinical stage at presentation, categorized as T1N0M0 vs other. Secondary outcomes included treatments received, treatment failure, and overall survival.

RESULTS

A total of 612 patients with anal squamous-cell carcinoma were included, with 26 of those patients diagnosed through a screening program. Patients with screen-detected cancers had greater odds of presenting with T1N0M0 tumors compared to unscreened patients (18 [69.2%] vs 84 [14.3%]; adjusted OR 9.95; 95% CI, 3.95-25.08). A propensity score-matched sensitivity analysis found similar results (OR 11.13; 95% CI, 4.67-26.52). Screened patients had greater odds of treatment with wide local excision alone, as opposed to any combination of chemotherapy, radiation therapy, and surgery (3 [12.5%] vs 18 [3.2%]; OR 4.38; 95% CI, 1.20-16.04). There were no statistically significant differences in treatment failure or overall survival between groups.

LIMITATIONS

The small number of screened patients limits the power of the analysis.

CONCLUSIONS

Screening for anal squamous-cell carcinoma among high-risk populations detects cancers at an earlier stage. Patients with screen-detected cancers also had a greater likelihood of being candidates for wide local excision alone, which may have spared them the morbidity associated with chemoradiotherapy or abdominoperineal resection. See Video Abstract.

CNCERES DE ANO EN PACIENTES PREVIAMENTE DETECTADOS POR CRIBADO VERSUS NO DETECTADOS ESTADIO DEL TUMOR Y RESULTADOS DEL TRATAMIENTO

ANTECEDENTES:Se han propuesto programas de cribado dirigidos a pacientes con alto riesgo de carcinoma anal de células escamosas; sin embargo, la evidencia a favor de la detección sigue sin estar clara.OBJETIVO:Este estudio tuvo como objetivo determinar si el cribado de pacientes de alto riesgo (predominantemente aquellos que viven con el VIH) detectó el carcinoma de células escamosas en una etapa más temprana en comparación con la práctica habitual de no cribado.DISEÑO:Este es un estudio de cohortes.CONFIGURACIÓN:Este estudio se realizó en un centro de atención cuaternaria en Canadá.PACIENTES:Los pacientes incluidos tenían al menos 18 años con un diagnóstico patológico de carcinoma de células escamosas anal invasivo entre 2002 y 2022.INTERVENCIONES:Los pacientes diagnosticados mediante un programa de cribado de alto riesgo se compararon con aquellos que no se sometieron a cribado.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue el estadio clínico en la presentación, categorizado como T1N0M0 versus otro. Los resultados secundarios incluyeron los tratamientos recibidos, el fracaso del tratamiento y la supervivencia general.RESULTADOS:Se incluyeron un total de 612 pacientes con carcinoma anal de células escamosas, con 26 de esos pacientes diagnosticados a través de un programa de cribado. Los pacientes con cánceres detectados mediante cribado tenían mayores probabilidades de presentar tumores T1N0M0 en comparación con los pacientes no cribados (18 [69.2%] frente a 84 [14.3%]; razón de probabilidad ajustada 9.95; intervalo de confianza del 95 % 3.95 -25.08). Un análisis de sensibilidad emparejado por puntaje de propensión encontró resultados similares (odds ratio 11.13; intervalo de confianza del 95% 4.67 -26.52; p < 0.001). Los pacientes examinados tenían mayores probabilidades de recibir tratamiento con escisión local amplia sola, en comparación con cualquier combinación de quimioterapia, radiación y cirugía (3 [12.5%] frente a 18 [3.2%]; razón de probabilidad 4.38; intervalo de confianza del 95 % 1.20 -16.04). No hubo diferencias estadísticamente significativas en el fracaso del tratamiento o la supervivencia global entre los grupos.LIMITACIONES:El pequeño número de pacientes evaluados limita el poder del análisis.CONCLUSIONES:La detección del carcinoma anal de células escamosas entre las poblaciones de alto riesgo detecta los cánceres en una etapa más temprana. Los pacientes con cánceres detectados mediante cribado también tenían una mayor probabilidad de ser candidatos para una escisión local amplia sola, lo que puede haberles evitado la morbilidad asociada con la quimiorradioterapia o la resección abdominoperineal. (Traducción --Dr. Aurian Garcia Gonzalez ).

Association of Frailty With Post-Operative Outcomes of Older Adults Undergoing Elective Ostomy Reversal

BACKGROUND

Ostomy reversal is a common surgical procedure; however, it is not without associated risks. Patient selection for this elective procedure is therefore critically important. Elderly patients represent a growing population and a substantial proportion of patients that present for evaluation after ostomy creation due to the most common etiologies. This study aims to assess the impact of frailty on the outcomes of ostomy reversal among older adults.

METHODS

Patients ≥65 years who underwent ostomy reversal from 2015 to 2019 were identified in the NSQIP database. Frailty was calculated using the 5-item Modified Frailty Index (MFI). Multivariate regression was performed to evaluate the association of frailty with post-operative 30-day mortality, 30-day serious complications, discharge to a facility, and 30-day readmission.

RESULTS

A total of 13,053 patients were included, of which 18.7% were frail (MFI ≥ 2). Patients who underwent colostomy reversal had higher rates of serious complications (P < .0001) and discharge to facility (P < .0001) compared to other reversals. In multivariate analysis, frailty was associated with increased odds of serious complications (OR 1.52, 95% CI 1.31-1.77), discharge to facility (OR 2.14, 95% CI 1.79-2.57), and readmission (OR 1.23, 95% CI 1.04-1.46), but not mortality. Frail patients had predicted probabilities 1.4 times higher for serious complications and 1.7-2.2 times greater for discharge to facility than non-frail patients.

CONCLUSIONS

Among older adults undergoing elective ostomy reversal, frailty is independently associated with increased odds of 30-day serious complications, discharge to facility, and 30-day readmission. As a potentially modifiable risk factor, identification of frailty offers the opportunity for shared decision-making and prehabilitation.

Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions: a retrospective cohort study

BACKGROUND

The surgical resection of rectal carcinoma is associated with a high risk of permanent stoma rate. Primary anastomosis rate is suggested to be higher in robot-assisted and transanal total mesorectal excision, but permanent stoma rate is unknown.

METHODS

Patients undergoing total mesorectal excision for MRI-defined rectal cancer between 2015 and 2017 in 11 centers highly experienced in laparoscopic, robot-assisted or transanal total mesorectal excision were included in this retrospective study. Permanent stoma rate, stoma-related complications, readmissions, and reoperations were registered. A multivariable regression analysis was performed for permanent stoma rate, stoma-related complications, and stoma-related reoperations.

RESULTS

In total, 1198 patients were included. Permanent stoma rate after low anterior resection (with anastomosis or with an end colostomy) was 40.1% in patients undergoing laparoscopic surgery, 21.3% in patients undergoing robot-assisted surgery, and 25.6% in patients undergoing transanal surgery (P < 0.001). Permanent stoma rate after low anterior resection with an anastomosis was 17.3%, 11.8%, and 15.1%, respectively. The robot-assisted and transanal techniques were independently associated with a reduction in permanent stoma rate in patients who underwent a low anterior resection (with anastomosis or with an end colostomy) (OR 0.39 [95% CI 0.25, 0.59] and OR 0.35 [95% CI 0.22, 0.55]), while this was not seen in patients who underwent a restorative low anterior resection. 45.4% of the patients who had a stoma experienced stoma-related complications, 4.0% were at least once readmitted, and 8.9% underwent at least one reoperation.

CONCLUSIONS

The robot-assisted and transanal techniques are associated with a lower permanent stoma rate in patients who underwent a low anterior resection.

Patient-Reported Sexual Function, Bladder Function and Quality of Life for Patients with Low Rectal Cancers with or without a Permanent Ostomy

BACKGROUND

Despite the increasing utilization of sphincter and/or organ-preservation treatment strategies, many patients with low-lying rectal cancers require abdominoperineal resection (APR), leading to permanent ostomy. Here, we aimed to characterize overall, sexual-, and bladder-related patient-reported quality of life (QOL) for individuals with low rectal cancers. We additionally aimed to explore potential differences in patient-reported outcomes between patients with and without a permanent ostomy.

METHODS

We distributed a comprehensive survey consisting of various patient-reported outcome measures, including the FACT-G7 survey, ICIQ MLUTS/FLUTS, IIEF-5/FSFI, and a specific questionnaire for ostomy patients. Descriptive statistics and univariate comparisons were used to compared demographics, treatments, and QOL scores between patients with and without a permanent ostomy.

RESULTS

Of the 204 patients contacted, 124 (60.8%) returned completed surveys; 22 (18%) of these had a permanent ostomy at the time of survey completion. There were 25 patients with low rectal tumors (≤5 cm from the anal verge) who did not have an ostomy at the time of survey completion, of whom 13 (52%) were managed with a non-operative approach. FACTG7 scores were numerically lower (median 20.5 vs. 22, p = 0.12) for individuals with an ostomy. Sexual function measures IIEF and FSFI were also lower (worse) for individuals with ostomies, but the results were not significantly different. MLUTS and FLUTS scores were both higher in individuals with ostomies (median 11 vs. 5, p = 0.06 and median 17 vs. 5.5, p = 0.01, respectively), suggesting worse urinary function. Patient-reported ostomy-specific challenges included gastrointestinal concerns (e.g., gas, odor, diarrhea) that may affect social activities and personal relationships.

CONCLUSIONS

Despite a limited sample size, this study provides patient-centered, patient-derived data regarding long-term QOL in validated measures following treatment of low rectal cancers. Ostomies may have multidimensional negative impacts on QOL, and these findings warrant continued investigation in a prospective setting. These results may be used to inform shared decision making for individuals with low rectal cancers in both the settings of organ preservation and permanent ostomy.

Autologous full-thickness skin in the repair of complex ventral hernias: an innovative step into the future of complex hernia repair?

The repair of complex ventral hernias, such as giant incisional or parastomal hernia, is associated with a high risk for complications and recurrence. Some serious complications are related to implantation of synthetic mesh as reinforcement material. Autologous full-thickness skin graft (FTSG) as reinforcement material in the repair of these complex hernias may offer a safe alternative. This is a review of the history of FTSG use in hernia surgery and the experiences of our research group regarding its application over the last decade. The results of FTSG used in the repair of giant ventral hernias are promising, and this method may already be recommended in selected cases. We have also conducted a translational chain of preclinical studies, based on a murine model, to gain a greater understanding of the behaviour of FTSG implanted in various positions in the abdominal wall. The use of intraperitoneal FTSG as reinforcement material in parastomal hernia repair is currently being evaluated in a randomised, controlled, multicentre study.

Survivorship in Early-Stage Rectal Cancer Patients Who Have Received Combined Modality Therapy

Survival rates in early-stage rectal cancer patients have increased over the past few decades. Societies such as the National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and European Society of Medical Oncology (ESMO) have proposed guidelines related to cancer survivorship care including formal recommendations to address the needs in early-stage rectal cancer survivors. These guidelines, in addition to new clinical research findings in survivorship will be reviewed, specifically looking at physical, psychosocial, and financial concerns in rectal cancer survivorship.

Risk factors and incidence of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma: A systematic review and meta-analysis

BACKGROUND

To further define the risk factors and incidence of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma.

METHODS

Records from five English databases and four Chinese databases. Odds ratios (OR) and 95 % confidence intervals (CI) were used to indicate the risk of inclusion of risk factors. The non-closure stoma rate used the risk difference (RD) and 95 % CI. Risk factors were evaluated for quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Risk factors of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma were Age ≥60 years[OR:1.57, 95%CI(1.44,1.72)], Tumor IV stage[OR:4.21, 95%CI(2.29,7.74)], American Society of Anesthesiologists (ASA)≥3[OR:1.48, 95%CI(1.33,1.65)], Neoadjuvant chemoradiotherapy[OR:1.41, 95%CI(1.09,1.82)],Open surgery[OR:1.45, 95%CI(1.09,1.93)], Postoperative chemotherapy[OR:1.37, 95%CI(1.03,1.82)], Anastomotic leakage[OR:4.61, 95%CI(2.86, 7.44)], Local recurrence[OR:7.16, 95%CI(4.70, 10.91)]. The rate of non-closure stoma after anterior resection for rectal cancer was: 0.20, 95 % CI (0.17, 0.23). The quality of evidence for stage IV tumors and anastomotic leakage was moderate, and other risk factors were low to very low.

CONCLUSIONS

Risk factors of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma were Age≥60 years, Tumor IV stage, ASA≥3, Neoadjuvant chemoradiotherapy, Open surgery, Postoperative chemotherapy, Anastomotic leakage, Local recurrence, and one in five anterior resection patients with a temporary stoma fails to close.

Patients' experiences of living with a stoma in rural areas in Northern Sweden

Introduction: Stoma complications are common and interfere with many aspects of everyday life. Stoma problems are usually managed by a specialised stoma nurse, a service not present in the rural areas of South Lapland in Sweden. The aim of this study was to describe how stoma patients in rural areas experience living with a stoma.Methods: A qualitative descriptive study with semi-structured interviews were conducted with 17 stoma patients living in rural municipalities and who received a part of their care at the local cottage hospital. Qualitative content analysis was employed.Results: Initially, the stoma was experienced as very depressing. Participants had difficulties in properly managing the dressing. Over time they learned how to properly care for their stoma, making their life easier. Both satisfaction and dissatisfaction with the healthcare were experienced. Those who were dissatisfied expressed a lack of competence in dealing with stoma-related problems.Conclusions: Living with a stoma in a rural area in northern Sweden is experienced as a learning process and acceptance of the stoma's existence is important. This study emphasises the need for increased knowledge of stoma-related problems in rural primary healthcare in order to help patients cope with everyday life.

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort

OBJECTIVE

To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).

BACKGROUND

AL after RC resection often results in a permanent stoma.

METHODS

This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.

RESULTS

This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).

CONCLUSIONS

The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.

Intimacy and survivors of cancer with ostomies: findings from the Ostomy Self-management Training trial

BACKGROUND

Many people with abdominal or pelvic cancers require an ostomy during surgical treatment, which can cause significant issues with physical and emotional intimacy in relationships.

AIM

To evaluate the effect of a telehealth-based education program on intimacy over time for survivors of cancer with ostomies.

METHODS

We performed a secondary analysis of our multicenter randomized controlled trial to determine intimacy outcomes and to compare the effects of the Ostomy Self-management Training (OSMT) program vs usual care. Partnered patients were included who provided answers to the City of Hope Quality of Life-Ostomy survey for at least 2 time points during the study. We evaluated the effect of baseline information, such as gender on intimacy.

OUTCOMES

The primary outcome was intimacy, estimated by a composite score created from questions within the City of Hope Quality of Life-Ostomy survey.

RESULTS

Of 216 enrolled volunteers, 131 had a partner: 68 in the OSMT arm and 63 in the usual care arm. Of these, 48 were women and 83 were men. The tumor types represented in this study were colorectal (n = 69), urinary (n = 45), gynecologic (n = 10), and other (n = 7; eg, melanoma, liposarcoma). From the cohort, 87 answered the 5 composite intimacy score questions at 2 time points, including baseline. There was significant improvement over time in composite intimacy scores for participants in the OSMT arm vs the usual care arm.

CLINICAL IMPLICATIONS

Our OSMT intervention had a positive effect on factors that contribute to intimacy for survivors of cancer with ostomies, suggesting that a survivorship curriculum can improve their experiences after ostomy surgery.

STRENGTHS AND LIMITATIONS

OSMT allowed for discussion of intimacy and other sensitive topics, which can be challenging. These discussions demonstrate benefit to participants and can serve as frameworks for cancer treatment providers. The focus of this work on partnered participants provides insight into the interpersonal challenges of a life with an ostomy, but it may overlook the important perspectives of nonpartnered participants and the partners themselves. Furthermore, limited power prevented us from conducting subgroup analyses exploring the effects of factors such as gender and tumor type on intimacy.

CONCLUSION

At 6-month follow-up, the novel intimacy composite score indicated improvement for participants completing the OSMT intervention. Future research studies with higher power will validate this intimacy measurement and identify intimacy differences in similar populations based on tumor type.

The impact of restorative proctectomy versus permanent colostomy on health-related quality of life after rectal cancer surgery using the patient-generated index

BACKGROUND

The impact of bowel dysfunction versus colostomy on quality of life after rectal cancer surgery is poorly understood.

BACKGROUND

To evaluate the quality of life after rectal cancer surgery in patients with colostomy versus restorative proctectomy.

METHODS

A mixed-methods study measuring quality of life using the Patient-Generated Index, patients were asked to list up to 5 areas of their life affected by their surgery. Areas were then weighted according to patients' preferences for improvement to generate a score from 0-100. The areas reported by patients were linked to the International Classification of Functioning for content analysis. Bowel dysfunction was measured using the low anterior resection syndrome score, and patients were then grouped according to (1) colostomy, (2) no/minor, or (3) major low anterior resection syndrome. Quality of life was compared between groups.

RESULTS

Overall, 121 patients were included (colostomy n = 39, restorative proctectomy n = 82). There were no differences in demographics, neoadjuvant radiotherapy, or time to follow-up between groups. In the restorative proctectomy group, 53% had no/minor, and 47% had major low anterior resection syndrome. Overall, patients with colostomy had significantly lower quality-of-life scores than those with restorative proctectomy. However, patients with major low anterior resection syndrome scored similarly to those with colostomy. On content analysis, patients with colostomies reported more problems with sexual function, body image, and sports. Patients with restorative proctectomy reported more problems with sleep, using transportation, and taking care of themselves.

CONCLUSION

Colostomy has a more detrimental impact on quality of life than restorative proctectomy. However, bowel dysfunction severity is important to consider. The patient experience between treatments differs.

Functional preservation benefits of minimal surgery for extramammary Paget's disease

As extramammary Paget's disease (EMPD) sometimes invades and metastasizes from the skin to the mucosa, radical surgical resection of these lesions is often difficult. The purpose of this study was to analyse the association between surgical margins and survival as well as the benefit of functional preservation over complete resection, in patients with EMPD. We retrospectively analysed 230 patients diagnosed with EMPD between 1969 and 2020. Patient and treatment characteristics were recorded. Since our centre is a specialized hospital and almost all patients were referred from other hospitals, we reviewed their referral letters. Prognostic factors and survival time were also analysed. Among 230 patients, 78 (33.9%) had positive margins. The presence of margin positive lesions increased the local recurrence rate but was not significantly correlated with survival. Of all the patients who had received a thorough explanation about the surgical procedure in the referring hospital, 43.8% were scheduled for surgeries that would result in functional impairment, and all of them had function-preserving surgeries at our hospital with a 10-year survival rate of 100%. Our result suggest that less invasive surgery preserves anogenital and urethral function may be an acceptable option for EMPD treatment.

Artificial intelligence based system for predicting permanent stoma after sphincter saving operations

Although the goal of rectal cancer treatment is to restore gastrointestinal continuity, some patients with rectal cancer develop a permanent stoma (PS) after sphincter-saving operations. Although many studies have identified the risk factors and causes of PS, few have precisely predicted the probability of PS formation before surgery. To validate whether an artificial intelligence model can accurately predict PS formation in patients with rectal cancer after sphincter-saving operations. Patients with rectal cancer who underwent a sphincter-saving operation at Taipei Medical University Hospital between January 1, 2012, and December 31, 2021, were retrospectively included in this study. A machine learning technique was used to predict whether a PS would form after a sphincter-saving operation. We included 19 routinely available preoperative variables in the artificial intelligence analysis. To evaluate the efficiency of the model, 6 performance metrics were utilized: accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve. In our classification pipeline, the data were randomly divided into a training set (80% of the data) and a validation set (20% of the data). The artificial intelligence models were trained using the training dataset, and their performance was evaluated using the validation dataset. Synthetic minority oversampling was used to solve the data imbalance. A total of 428 patients were included, and the PS rate was 13.6% (58/428) in the training set. The logistic regression (LR), Gaussian Naïve Bayes (GNB), Extreme Gradient Boosting (XGB), Gradient Boosting (GB), random forest, decision tree and light gradient boosting machine (LightGBM) algorithms were employed. The accuracies of the logistic regression (LR), Gaussian Naïve Bayes (GNB), Extreme Gradient Boosting (XGB), Gradient Boosting (GB), random forest (RF), decision tree (DT) and light gradient boosting machine (LightGBM) models were 70%, 76%, 89%, 93%, 95%, 79% and 93%, respectively. The area under the receiving operating characteristic curve values were 0.79 for the LR model, 0.84 for the GNB, 0.95 for the XGB, 0.95 for the GB, 0.99 for the RF model, 0.79 for the DT model and 0.98 for the LightGBM model. The key predictors that were identified were the distance of the lesion from the anal verge, clinical N stage, age, sex, American Society of Anesthesiologists score, and preoperative albumin and carcinoembryonic antigen levels. Integration of artificial intelligence with available preoperative data can potentially predict stoma outcomes after sphincter-saving operations. Our model exhibited excellent predictive ability and can improve the process of obtaining informed consent.

PHaLIR: prevent hernia after loop ileostomy reversal-a study protocol for a randomized controlled multicenter study

BACKGROUND

Rectal cancer is a common cancer worldwide. Surgery for rectal cancer with low anterior resection often includes the formation of a temporary protective loop ileostomy. The temporary ostomy is later reversed in a separate operation. One complication following stoma closure is the development of a hernia at the former stoma site, and this has been reported in 7-15% of patients. The best method to avoid hernia after stoma closure is unclear. The most common closure is by suturing only, but different forms of mesh have been tried. Biological mesh has in a randomized trial halved hernia incidence after stoma reversal. Biosynthetic mesh and retromuscular mesh are currently being evaluated in ongoing studies.

METHODS

The present multicenter, double-blinded, randomized, controlled study will compare standard suture closure of the abdominal wall in loop ileostomy reversal with retromuscular synthetic mesh at the stoma site. The study has been approved by the Regional Ethical Review board in Stockholm. Patients aged 18-90 years, operated on with low anterior resection and a protective loop ileostomy for rectal cancer and planned for ileostomy reversal, will be considered for inclusion in the study. Randomization will be 1:1 on the operation day with concealed envelopes. The estimated sample size is intended to evaluate the superiority of the experimental arm and to detect a reduction of hernia occurrence from 12 to 3%. The operation method is blinded to the patients and in the chart and for the observer at the 30-day follow-up. The main outcome is hernia occurrence at the stoma site within 3 years postoperatively, diagnosed through CT with strain. Secondary outcomes are operation time, length of hospital stay, pain, and 30-day complications.

DISCUSSION

This double-blinded randomized controlled superiority study will compare retromuscular synthetic mesh during the closure of loop ileostomy to standard care. If this study can show a lower frequency of hernia with the use of prophylactic mesh, it may lead to new surgical guidelines during stoma closure.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03720262. Registered on October 25, 2018.

Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning

PURPOSE

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress.

METHODS

CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

RESULTS

Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = -0.087, 95% CI = -0.135 to -0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased.

CONCLUSION

CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

Comparison of sexual function of people with colorectal cancer with and without colostomy bag in Iran: a comparative cross-sectional study

The aim of this study was to investigate and compare sexual function in individuals with colorectal cancer, with and without a colostomy bag. A quantitative, descriptive-comparative design was employed, and a cluster random sampling method was used to recruit 252 patients with colorectal cancer. Data collection tools included a participants characteristics form, the International Index of Erectile Function (IIEF) for men, and the Female Sexual Function Index (FSFI) for women. The mean IIEF total score for men with a colostomy was 26.17 ± 15.30, and for men without a colostomy, it was 29.05 ± 17.14. The mean FSFI total score for women with a colostomy was 6.40 ± 7.21, and for women without a colostomy, it was 9.10 ± 14.67. There was no statistically difference in IIEF scores between men with and without colostomy bags (p > 0.05). However, women with colostomy bags had significantly lower FSFI scores compared to women without colostomy bags (p < 0.05). Addressing sexual concerns in individuals with colorectal cancer is crucial for enhancing their sexual well-being and overall quality of life. Comprehensive support, timely interventions, and targeted services are essential to help patients navigate the challenges and improve their overall well-being.

A prediction model for moderate to severe cancer-related fatigue in colorectal cancer after chemotherapy: a prospective case‒control study

AIMS

The study aims to develop a model to predict the risk of moderate to severe cancer-related fatigue (CRF) in colorectal cancer patients after chemotherapy.

METHODS

The study population was colorectal cancer patients who received chemotherapy from September 2021 to June 2022 in a grade 3 and first-class hospital. Demographic, clinical, physiological, psychological, and socioeconomic factors were collected 1 to 2 days before the start of chemotherapy. Patients were followed up for 1 to 2 days after the end of chemotherapy to assess fatigue using the Piper Fatigue Scale. A random sampling method was used to select 181 patients with moderate to severe CRF as the case group. The risk set sampling method was used to select 181 patients with mild or no CRF as the control group. Logistic regression, back-propagation artificial neural network (BP-ANN), and decision tree models were constructed and compared.

RESULTS

A total of 362 patients consisting of 241 derivation samples and 121 validation samples were enrolled. Comparing the three models, the prediction effect of BP-ANN was the best, with a receiver operating characteristic (ROC) curve of 0.83. Internal and external verification indicated that the accuracy of prediction was 70.4% and 80.8%, respectively. Significant predictors identified were surgery, complications, hypokalaemia, albumin, neutrophil percentage, pain (VAS score), Activities of Daily Living (ADL) score, sleep quality (PSQI score), anxiety (HAD-A score), depression (HAD-D score), and nutrition (PG-SGA score).

CONCLUSIONS

BP-ANN was the best model, offering theoretical guidance for clinicians to formulate a tool to identify patients at high risk of moderate to severe CRF.

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gastrointestinal cancer

Gastrointestinal (GI) cancers, including esophageal, gastroesophageal junction, gastric, duodenal and distal small bowel, biliary tract, pancreatic, colon, rectal, and anal cancer, comprise a heterogeneous group of malignancies that impose a significant global burden. Immunotherapy has transformed the treatment landscape for several GI cancers, offering some patients durable responses and prolonged survival. Specifically, immune checkpoint inhibitors (ICIs) directed against programmed cell death protein 1 (PD-1), either as monotherapies or in combination regimens, have gained tissue site-specific regulatory approvals for the treatment of metastatic disease and in the resectable setting. Indications for ICIs in GI cancer, however, have differing biomarker and histology requirements depending on the anatomic site of origin. Furthermore, ICIs are associated with unique toxicity profiles compared with other systemic treatments that have long been the mainstay for GI cancer, such as chemotherapy. With the goal of improving patient care by providing guidance to the oncology community, the Society for Immunotherapy of Cancer (SITC) convened a panel of experts to develop this clinical practice guideline on immunotherapy for the treatment of GI cancer. Drawing from published data and clinical experience, the expert panel developed evidence- and consensus-based recommendations for healthcare professionals using ICIs to treat GI cancers, with topics including biomarker testing, therapy selection, and patient education and quality of life considerations, among others.

Surgical treatment of stomal prolapse: A systematic review and meta-analysis of the literature

AIM

This study aimed to assess success, recurrence, and overall complication rates among different surgical procedures for stomal prolapse.

METHODS

This study was a PRISMA-compliant systematic review. PubMed, Scopus, and Google Scholar were searched until March 2022. Studies that assessed surgical treatments of stomal prolapse in adults were included. The primary outcome was recurrence of stomal prolapse and the secondary outcome was 30-day complications. A random-effect meta-analysis was used to estimate the weighted mean rates of recurrence.

RESULTS

Six studies published (111 patients; 103 males) were included. 52 (46.8%) patients had end colostomies, 35 (31.5%) had loop colostomies. Seven procedures were assessed and included local stoma reconstruction (40%), stapled local repair (27%), modified Altemeier technique (10%), mesh strip repair (9%), stoma relocation (6%) redo laparotomy repair (5%), and colectomy and end ileostomy (3%). The weighted mean recurrence rate after local stoma reconstruction was 37.2% (95% CI: -1.8 to 76.3), higher than that after the stapled local repair technique (14.9%; 95% CI: 1.7-28.2). The crude recurrence rate of the modified Altemeier technique was 20%, and of stoma relocation was 66.6%. No recurrence was detected after the mesh strip technique (n = 10). The median follow-up ranged between 7 months and 2.5 years.

CONCLUSION

Several surgical techniques are available to treat stomal prolapse. Local stoma reconstruction may be associated with high rates of recurrence while the stapled local repair and modified Altemeier procedure has relatively low recurrence. Further larger studies are needed to compare the efficacy of these techniques.

Long-term incidence of depression in rectal cancer patients with or without stoma: a population-based cohort study

Purpose

Significant improvements have been made in the surgical treatment of rectal cancer with a higher sphincter-saving rate without compromising oncologic results. There have been studies about the quality of life of rectal cancer patients after surgery. However, no study has reported the long-term annual incidence of depression after rectal cancer surgery according to stoma status. The objective of this study was to determine the annual incidence of depression after rectal cancer surgery and the factors affecting it, especially the prevalence of depression according to the presence or duration of a stoma.

Methods

Using the Korea National Health Insurance Service database, patients who underwent radical surgery for rectal cancer from 2002 to 2019 were searched. We analyzed the incidence and risk factors of depression in patients who underwent radical surgery for rectal cancer according to stoma status.

Results

Annual incidence of depression in rectal cancer patients was decreasing annually for 15 years after surgery. There was no statistically significant difference in the incidence of depression according to the stoma status. However, the diagnosis of depression within 1 year after surgery was statistically significantly increased in the permanent stoma group.

Conclusion

There was no difference in the overall incidence of depressive disorders among patients with rectal cancer based on their stoma status. However, a permanent stoma seems to increase the incidence in the first year after surgery. Education and intensive assessments of depressive disorders in patients with permanent stoma within 1 year after surgery are needed, particularly for female patients who are under 50 years old.

The sexuality experience of stoma patients: a meta-ethnography of qualitative research

BACKGROUND

As the quality of life of stoma patients has become a research hotspot, sexual health as an integral part of patients' lives has received more and more attention. However, there is a lack of comprehensive reviews on the sexual experiences of patients with stomas. This study aims to synthesize the qualitative literature on the subjective experience of stoma patients' sexual life, to identify their sexual needs, and to provide evidence for the content and methods of sexual health interventions for healthcare professionals.

METHODS

PubMed, Embase, Web of Science, CINAHL, and Scopus were searched for qualitative studies on the sexual experience of stoma patients (from the inception to January 2023). Titles, abstracts, and full texts were reviewed by two researchers. We used the Critical Appraisal Program (CASP) checklist to assess the quality of included articles.

RESULTS

A total of 1388 articles were retrieved, and eight studies were included. Data was extracted, including three main themes: 1) sexual problems due to changes in physical function and psychological disorders; 2) the relationship with spouse changes; 3) the cognition of sexual life and the need for sexual knowledge.

CONCLUSION

Healthcare professionals should pay attention to the sexual life status and sexual health needs of stoma patients and their partners, and give professional guidance and support in treatment and nursing to improve the quality of sexual life of stoma patients.

Body Image Issues in Patients With Colorectal Cancer: A Scoping Review

BACKGROUND

Stomas in colorectal cancer (CRC) survivors lead to body image problems. Advances in treatment help reduce the rate of stoma formation, but body image distress is still frequently experienced in CRC survivors.

OBJECTIVES

This review is aimed toward mapping and describing the state of knowledge regarding body image in patients with CRC.

METHODS

A systematic literature search complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Screening and data extraction were performed by 2 reviewers independently for all potentially eligible studies.

RESULTS

A total of 56 eligible articles were selected. The majority of these studies were quantitative studies (85%). The eligible studies were classified into 4 broad categories: instruments used to assess body image, prevalence of body image distress, factors related to body image, and impact of body image distress. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-CR38) colorectal questionnaire was the most common measurement tool found among the reviewed studies (70%), and body image distress was reported by 25.5% to 86% of participants. Excluding gender, age, type of surgery, adjuvant therapy, time from diagnosis, social support, and stoma status, changes in bowel habits was identified as affecting the body image of patients with CRC.

CONCLUSION

Changing bowel habits emerged as a significant factor causing body image distress for CRC survivors.

IMPLICATIONS FOR PRACTICE

Clinicians should raise awareness about body image distress in patients with CRC, focus on finding effective measures and interventions intended to help alleviate symptoms of bowel dysfunction, and prepare patients to adapt to altered bowel functions.