1
|
Blanco N, Oliva I, Tejedor P, Pastor E, Alvarellos A, Pastor C, Baixauli J, Arredondo J. ILEOSTIM trial: a study protocol to evaluate the effectiveness of efferent loop stimulation before ileostomy reversal. Tech Coloproctol 2023; 27:1251-1256. [PMID: 37106220 PMCID: PMC10638139 DOI: 10.1007/s10151-023-02807-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE A protective loop ileostomy is the most useful method to reduce sequelae in the event of an anastomotic leakage (AL) after rectal cancer surgery. However, it requires an additional stoma reversal surgery with its own potential complications. Postoperative ileus (POI) remains the most common complication after ileostomy reversal, which leads to an increase in morbidity, length of hospital stay (LOS) and overall healthcare costs. Several retrospective studies carried out in this field have concluded that there are insufficient evidence-based recommendations about the routine application of preoperative bowel stimulation in clinical practice. Here we discuss whether stimulation of the efferent limb before ileostomy reversal might reduce POI and improve postoperative outcomes. METHODS This is a multicentre randomised controlled trial to determine whether mechanical stimulation of the efferent limb during the 2 weeks before the ileostomy reversal would help to reduce the development of POI after surgery. This study was registered on Clinicaltrials.gov (NCT05302557). Stimulation will consist of infusing a solution of 500 ml of saline chloride solution mixed with a thickening agent (Resource©, Nestlé Health Science; 6.4 g sachet) into the distal limb of the ileostomy loop. This will be performed within the 2 weeks before ileostomy reversal, in an outpatient clinic under the supervision of a trained stoma nurse. CONCLUSION The results of this study could provide some insights into the preoperative management of these patients.
Collapse
Affiliation(s)
- N Blanco
- Department of General Surgery, Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Navarra, Spain
| | - I Oliva
- Department of General Surgery, University Hospital of León, León, Spain
| | - P Tejedor
- Department of General Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - E Pastor
- Department of General Surgery, University Hospital of León, León, Spain
| | - A Alvarellos
- Department of General Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - C Pastor
- Department of General Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - J Baixauli
- Department of General Surgery, Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Navarra, Spain
| | - J Arredondo
- Department of General Surgery, Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Navarra, Spain.
| |
Collapse
|
2
|
Zeng Z, Liu Y, Wu K, Li D, Lai H, Zhang B. Efficacy and Safety of Fluoroscopy-Guided Self-Expandable Metal Stent Placement for Treatment of Malignant Colorectal Obstruction. Dig Dis Sci 2023; 68:939-947. [PMID: 35653010 DOI: 10.1007/s10620-022-07557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/02/2022] [Indexed: 12/09/2022]
Abstract
AIM To investigate long-term outcomes after SEMS insertion in patients with malignant colorectal obstruction and to identify the risk factors for complications. METHODS The data of 119 patients with malignant colorectal obstruction who received SEMS insertion between March 2014 and February 2020 were retrospectively analyzed. Patients were divided into two groups according to the intent of treatment, i.e., stenting as "bridge to surgery" (surgical group) and stenting for palliation (palliative group). Technical and clinical success rates and incidence of complications were compared between the two groups. RESULTS The overall technical and clinical success rates were 97.5% and 96.6%, respectively. The technical and clinical success rates and complication rate were comparable between the two groups. In the palliative group, the mean stent patency time was 230 days. Patency rates were not significantly different between primary CRC and recurrent CRC. Incidence of complications was higher in the palliative group than in the surgical group. In multivariate analysis, chemotherapy before stent implantation may increase the risk of stent-related complications, whereas chemotherapy after stent implantation did not. Additionally, the factors independently associated with complications were female sex and preoperative chemotherapy. CONCLUSIONS SEMS under fluoroscopic guidance is a safe and effective treatment for malignant colorectal obstruction. For patients with resectable CRC, stent placement can serve as a bridge to elective surgery. It is worth noting that adjuvant chemotherapy between SEMS and surgery did not increase the complications. For patients with recurrent CRC, stent placement can relieve symptoms, alleviate pain, and improve quality of life.
Collapse
Affiliation(s)
- Zhaofei Zeng
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yang Liu
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ketong Wu
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dan Li
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haiyang Lai
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bo Zhang
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
3
|
From Formation to Closure: Aggregate Morbidity and Mortality Associated With Defunctioning Loop Ileostomies. Dis Colon Rectum 2022; 65:1135-1142. [PMID: 34840304 DOI: 10.1097/dcr.0000000000002185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Defunctioning loop ileostomies are used commonly, but there are significant morbidities. OBJECTIVE This study aimed to describe the morbidity and mortality associated with the formation and closure of defunctioning loop ileostomies. DESIGN This descriptive study is based on electronic health records and claims data. SETTINGS This study was conducted at academic and community hospitals in Ontario, Canada. PATIENTS Adult patients who had a low anterior resection with concurrent defunctioning loop ileostomy from 2002 to 2014 were included. MAIN OUTCOME MEASURES Outcomes of interest included 30-day major complications, acute kidney injury, transfusion, and deep space infection. The rate of ileostomy reversal and the percentage of permanent ostomies were also collected. RESULTS The cohort consists of 4658 patients who underwent low anterior resection with concurrent defunctioning loop ileostomy. The 30-day, 90-day, and 1-year mortality rates of these patients were 1.2%, 2.2%, and 5.1%. The rate of reoperation was 5.5%, the rate of hospital readmission was 13.4%, the rate of major complications was 28.5%, the rate of deep organ/space infection requiring percutaneous intervention was 5.2%, and the rate of acute kidney injury requiring hospitalization was 10.4%. Eighty-six percent had their ileostomy reversed, leaving 13.2% with a permanent ostomy. After ileostomy reversal, 30-day and 90-day mortality rates were 0.6% and 0.9%. The rate of major complications was 10.3%, bowel obstruction 7%, ventral hernia 10.5%, deep space infection 1.7%, and repeat operation 2.3%. LIMITATIONS This study is based on electronic health records and claims data and, thus, the accuracy of results depends on the accuracy of data administration' which can be variable across institutions. CONCLUSIONS Morbidity and mortality of defunctioning loop ileostomies are significant. One in 8 patients will have a permanent ostomy. See Video Abstract at http://links.lww.com/DCR/B810 . DESDE LA FORMACIN HASTA EL CIERRE AGREGADA MORBILIDAD Y MORTALIDAD ASOCIADA CON LAS ILEOSTOMAS EN ASA DERIVATIVA ANTECEDENTES:Las ileostomías en asa derivativa se utilizan con frecuencia, pero existen morbilidades importantes.OBJETIVO:Describir la morbilidad y mortalidad asociadas con la formación y cierre de ileostomías en asa derivativa.DISEÑO:Estudio descriptivo basado en historias clínicas electrónicas y datos de reclamaciones.ENTORNO CLINICO:Hospitales académicos y comunitarios en Ontario, Canadá.PACIENTES:Pacientes adultos sometidos a resección anterior baja con concurrente ileostomía en asa derivativa de 2002 a 2014.PRINCIPALES MEDIDAS DE VALORACION:Los resultados de interés incluyeron complicaciones mayores a los 30 días, lesión renal aguda, transfusión e infección del espacio profundo. También se recolectó la tasa de reversión de la ileostomía y el porcentaje de ostomías permanentes.RESULTADOS:La cohorte consistió de 4658 pacientes sometidos a resección anterior baja con concurrente ileostomía en asa derivativa. La mortalidad de estos pacientes, a treinta días, 90 días y un año, fue del 1,2%, 2,2% y 5,1%, respectivamente. La tasa de reintervención fue del 5,5%, el reingreso hospitalario fue del 13,4%, la complicación mayor fue del 28,5%, la infección profunda de órganos / espacios que requirieron intervención percutánea fue del 5,2%, y la lesión renal aguda que requirió hospitalización fue del 10,4%. Ochenta y seis por ciento tuvieron reversión de su ileostomía, dejando al 13.2% con una ostomía permanente. Después de la reversión de la ileostomía, la mortalidad a los 30 días y 90 días fue de 0,6% y 0,9%, respectivamente. La tasa de complicaciones mayores fue del 10,3%, obstrucción intestinal del 7%, hernia ventral del 10,5%, infección del espacio profundo del 1,7% y reintervención del 2,3%.LIMITACIONES:El estudio se basa en registros médicos electrónicos y datos de reclamos y, por lo tanto, la precisión de los resultados depende de la precisión en la administración de datos, que pueden variar entre instituciones.CONCLUSIONES:La morbilidad y la mortalidad de las ileostomías en asa derivativa son significativas. Uno de cada 8 pacientes tendrá una ostomía permanente. Consulte Video Resumen en http://links.lww.com/DCR/B810 . (Traducción-Dr. Fidel Ruiz Healy ).
Collapse
|
4
|
Continuing Care Bundle in Elderly Patients with Rectal Cancer after Radical Resection with Permanent Stoma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4065886. [PMID: 35979010 PMCID: PMC9377867 DOI: 10.1155/2022/4065886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022]
Abstract
Objective. A continuing care bundle can achieve a better outcome than a single implementation after discharge. This study aims to investigate the effect of this intervention in elderly patients with rectal cancer after radical resection with a permanent stoma. Methods. Elderly patients diagnosed with rectal cancer underwent radical resection with permanent stoma, they were divided into the control group (n = 42) and bundle group (n = 42). The control group received the conventional care, and the bundle group received the continuing care bundle in addition to the conventional care. At 1- and 3-month after discharge, self-efficacy, self-care knowledge, ability to change stoma appliances, negative emotions, quality of life, and patient satisfaction were observed. Results. The increased levels of self-efficacy, self-care knowledge, and ability to change stoma appliances were displayed in the bundle group after discharge as compared with that in the control group, along with the enhanced score of SF-36 subscales, including physical function (PF), role physical (RP), global health (GH) and vitality (V), social function (SF), and mental health (MH). Furthermore, patients showed alleviated depression and anxiety after the continuing care bundle as compared to those after conventional care. Besides, the bundle groups had higher patient satisfaction than the control group. Conclusions. Continuing care bundle can serve as an effectiveness intervention in elderly rectal cancer patients after radical resection with permanent stoma via increasing self-efficacy and self-care knowledge, enhancing the ability to change stoma appliance, reliving the negative emotion, and improving quality of life and patient satisfaction.
Collapse
|
5
|
Ocaña J, García-Pérez JC, Labalde-Martínez M, Rodríguez-Velasco G, Moreno I, Vivas A, Clemente-Esteban I, Ballestero A, Abadía P, Ferrero E, Fernández-Cebrián JM, Die J. Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study. Tech Coloproctol 2022; 26:645-653. [PMID: 35596903 DOI: 10.1007/s10151-022-02620-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.
Collapse
Affiliation(s)
- J Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain.
| | - J C García-Pérez
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - M Labalde-Martínez
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - G Rodríguez-Velasco
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - I Moreno
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - A Vivas
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | | | - A Ballestero
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - P Abadía
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - E Ferrero
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - J M Fernández-Cebrián
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - J Die
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| |
Collapse
|
6
|
Huang SH, Tsai KY, Tsai TY, You JF, Yeh CY, Hsieh PS, Tang R, Chiang JM, Tsai WS. Preoperative risk stratification of permanent stoma in patients with non-metastatic mid and low rectal cancer undergoing curative resection and a temporary stoma. Langenbecks Arch Surg 2022; 407:1991-1999. [DOI: 10.1007/s00423-022-02503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
|
7
|
Mizuuchi Y, Tanabe Y, Sada M, Tamura K, Nagayoshi K, Nagai S, Watanabe Y, Tamiya S, Nakata K, Ohuchida K, Nakano T, Nakamura M. Cross-sectional area of psoas muscle as a predictive marker of anastomotic failure in male rectal cancer patients: Japanese single institutional retrospective observational study. Ann Coloproctol 2022; 38:353-361. [DOI: 10.3393/ac.2022.00122.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/11/2022] [Indexed: 10/31/2022] Open
|
8
|
Body Image Issues in Patients With Colorectal Cancer: A Scoping Review. Cancer Nurs 2022; 46:233-247. [PMID: 35349543 DOI: 10.1097/ncc.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
Collapse
|
9
|
Mungai MW, Abere MN, Avula EK. Quality of life of ostomates at a teaching and referral hospital in Kenya. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S24-S32. [PMID: 34889671 DOI: 10.12968/bjon.2021.30.22.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Ostomy surgery is performed to maintain gastrointestinal function. However, there is a lack of knowledge and experience about ostomies among patients and clinicians in public hospitals in Kenya. The issue is compounded by the social isolation and stigma ostomates face in the wards and in the community after discharge. Although it is not easy to identify the exact number of ostomates in Kenya and other African countries, there is need to shift the focus from curing symptoms in ostomates to maximising patients' quality of life (QoL) and integrating services for ostomates in mainstream public hospitals. AIM To understand the effects of ostomies on patients' QoL, with a focus on nutrition, psychosocial aspects and challenges around sexuality after ostomy creation. METHOD A descriptive study was undertaken using an interviewer-administered QoL questionnaire with 81 patients. RESULTS Most patients were male (54%); the largest age group was 35-44 years (24.7%). Colorectal carcinoma, intestinal obstruction and traumatic injuries were the main indications for ostomy. Ostomates resumed sexual activity, but did not find it fulfilling (P=0.002). Most reported feeling depressed, with suicidal attempts that negatively correlated with QoL. Ostomates adjusted their diets regardless of whether their level of QoL was poor, fair, good or excellent after ostomy creation (P=0.564). CONCLUSION Ostomates experience low QoL. Patients' lives can be improved by focusing on providing individualised ostomy care services after discharge. Enhancing stoma therapy training for nurses and running ostomy clinics alongside mainstream services, as well as support for ostomates towards enrolment into the country's National Hospital Insurance Fund, will also improve patients' QoL.
Collapse
Affiliation(s)
- Margaret Wanjiru Mungai
- Deputy Director Nursing/Wound Care Nurse Specialist, Moi Teaching and Referral Hospital, Directorate of Nursing, Eldoret, Kenya
| | - Mercy Nyanchama Abere
- Senior Principal Nursing Officer, Quality Assurance Officer, Moi Teaching and Referral Hospital, Directorate of Nursing, Eldoret, Kenya
| | - Edward Kilamonda Avula
- Perioperative and Stoma Therapy Nurse, Moi Teaching and Referral Hospital, Directorate of Nursing, Eldoret, Kenya
| |
Collapse
|
10
|
Makker PGS, Koh CE, Solomon MJ, Ratcliffe J, Steffens D. Functional outcomes following pelvic exenteration: results from a prospective cohort study. Colorectal Dis 2021; 23:2647-2658. [PMID: 34346149 DOI: 10.1111/codi.15834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022]
Abstract
AIM Postoperative functional outcomes following pelvic exenteration surgery for treatment of advanced or recurrent pelvic malignancies are poorly understood. The aim of this study was to determine the short-term functional outcomes following pelvic exenteration surgery using objective measures of physical function. METHOD Patients undergoing pelvic exenteration surgery between January 2017 and May 2020 were recruited at a single quaternary referral hospital in Sydney, Australia. The primary measures were the 6-min walk test (6MWT) and the five times sit to stand (5STS) test. Data were collected at baseline (preoperatively), 10 days postoperatively and at discharge from hospital, and were analysed according to tumour type, extent of exenteration, sacrectomy, length of hospital stay, major nerve resection and postoperative complications. RESULTS The cohort of patients that participated in functional assessments consisted of 135 patients, with a median age of 61 years. Pelvic exenteration patients had a reduced 6MWT distance preoperatively compared to the general population (P < 0.001). Following surgery, we observed a further decrease in 6MWT distance (P < 0.001) and an increase in time to complete 5STS (P < 0.001) at postoperative day 10 compared to baseline, with a slight improvement at discharge. There were no differences in 6MWT and 5STS outcomes between patients based on comparisons of surgical and oncological factors. CONCLUSION Pelvic exenteration patients are functionally impaired in the preoperative period compared to the general population. Surgery causes a further reduction in physical function in the short term; however, functional outcomes are not impacted by tumour type, extent of exenteration, sacrectomy or nerve resection.
Collapse
Affiliation(s)
- Preet G S Makker
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - James Ratcliffe
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center. Gastroenterol Res Pract 2021; 2021:5592721. [PMID: 34335738 PMCID: PMC8294951 DOI: 10.1155/2021/5592721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background The optimal timing of temporary ileostomy closure with respect to the time of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer remains unclear. The aim of this study is to investigate the clinical and oncological outcomes of ileostomy closure before, during, and after adjuvant chemotherapy following curative rectal cancer resection. Methods Patients diagnosed with rectal adenocarcinoma who underwent low anterior resection and temporary loop ileostomy during May 2015 and September 2019 were retrospectively evaluated. Patients undergoing ileostomy closure before adjuvant chemotherapy (Group I) were compared to patients undergoing closure during (Group II) and after (Group III) adjuvant chemotherapy. Results A total of 225 patients were evaluated for eligibility, and 132 were finally selected and divided into 3 groups (24 in Group I, 53 in Group II, and 55 in Group III). No significant differences were observed in operative time, postoperative hospital stay, postoperative complications, total adjuvant chemotherapy cycles, and low anterior resection syndrome scores among the three groups. There was no significant difference in disease-free survival (p = 0.834) and overall survival (p = 0.462) between the three groups. Conclusion Temporary ileostomy closure before adjuvant chemotherapy following curative rectal cancer resection can achieve a clinical and oncological safety level equal to stoma closure during or after chemotherapy in selected patients.
Collapse
|
12
|
Song L, Pang Y, Zhang J, Tang L. Body image in colorectal cancer patients: A longitudinal study. Psychooncology 2021; 30:1339-1346. [PMID: 33797154 DOI: 10.1002/pon.5688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess changes in body image distress (BID) over time, identify factors associated with BID, and explore the mediating role of body image on the longitudinal association between stoma status (permanent stoma, temporary stoma, or nonstoma) and psychological distress in postoperative colorectal cancer (CRC) patients in China. METHODS Participants (N = 255) 1-2 weeks postsurgery completed self-report questionnaires assessing BID (Body Image Scale) and psychosocial distress (Distress Thermometer, Hospital Anxiety and Depression Scale); 212 (83%) completed 6-month follow-up surveys. Generalized estimating equations were used to identify factors associated with BID for longitudinal data analysis. RESULTS A total of 46.7% of participants reported BID at follow-up. Prevalence of BID and BID scores did not significantly change over time in the total sample. Body image scores decreased in patients whose temporary stoma was removed during follow-up (p < 0.05). Prevalence of BID decreased in nonstoma patients at follow-up (p < 0.05). There were significant decreases in the prevalence and scores of distress, anxiety, and depression between baseline and follow-up (p < 0.001). Stoma presence, later clinical stages, greater distress, anxiety, and depression were risk factors for poorer body image. Body image had partial mediating effects on the longitudinal association between stoma status and distress. CONCLUSIONS Our findings indicate that BID remains stable even as psychological distress decreases. BID should be addressed early postoperation to avoid persistent impairment in CRC patients.
Collapse
Affiliation(s)
- Lili Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jie Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department 3 of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lili Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| |
Collapse
|
13
|
Pang NQ, Chan DKH, Lau J, Chew E, Yip LTS, Tan KK. Quality of life in colorectal cancer patients with stoma or adjuvant therapy. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:444-446. [PMID: 34100524 DOI: 10.47102/annals-acadmedsg.2020343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ning Qi Pang
- University Surgical Cluster, National University Health System, Singapore
| | | | | | | | | | | |
Collapse
|
14
|
Tamura K, Matsuda K, Horiuchi T, Noguchi K, Hotta T, Takifuji K, Iwahashi M, Iwamoto H, Mizumoto Y, Yamaue H. Laparoscopic anterior resection with or without transanal tube for rectal cancer patients - A multicenter randomized controlled trial. Am J Surg 2021; 222:606-612. [PMID: 33413874 DOI: 10.1016/j.amjsurg.2020.12.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In rectal cancer surgery, insertion of transanal tube has been shown to have efficacy to prevent anastomotic leakage. This randomized controlled study aims to clarify the incidence of anastomotic leakage with or without transanal tube in patients with rectal cancer. METHODS Patients who underwent elective low anterior resection were randomly allocated to either have transanal tube insertion or not for five days after surgery. We examined the incidence of anastomotic leakage, postoperative 30-day morbidity and mortality. RESULTS 157 patients were randomized to the transanal tube group or the no-transanal tube group. Symptomatic anastomotic leakage occurred in six patients (7.6%) of the former group and eight patients (10.3%) in the latter group, without significant difference (p = 0.559). There was also no significant difference in morbidity between groups (p = 0.633) and no mortality was detected. CONCLUSIONS Transanal tube insertion had no significant benefit towards prevention of anastomotic leakage in rectal cancer surgery.
Collapse
Affiliation(s)
- Koichi Tamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kenji Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tetsuya Horiuchi
- Department of Surgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Kohei Noguchi
- Department of Surgery and Endoscopic Surgery, Izumiotsu Municipal Hospital, Osaka, Japan
| | - Tsukasa Hotta
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, Wakayama, Japan
| | | | - Makoto Iwahashi
- Department of Surgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Hiromitsu Iwamoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuki Mizumoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
| |
Collapse
|
15
|
Keane C, Sharma P, Yuan L, Bissett I, O'Grady G. Impact of temporary ileostomy on long-term quality of life and bowel function: a systematic review and meta-analysis. ANZ J Surg 2019; 90:687-692. [PMID: 31701636 DOI: 10.1111/ans.15552] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Defunctioning ileostomy is widely used to protect a low colorectal anastomosis. However, the use of an ileostomy may have an impact on long-term bowel function and quality of life after anterior resection. The objectives were to compare bowel function and quality of life outcomes between patients undergoing an anterior resection for rectal cancer, with and without the formation of a diverting ileostomy, and to compare outcomes for early versus late closure of diverting ileostomy. METHOD A systematic literature review was performed to identify studies published between 2007 and 2018 comparing bowel function and quality of life outcomes after an anterior resection for rectal cancer in those with and without formation of a diverting ileostomy. RESULTS Four studies (three randomized controlled trials) reported bowel function and quality of life outcomes. Pooled analysis for 227 participants showed that having an ileostomy is associated with twice the risk of suffering from low anterior resection syndrome (odds ratio (major low anterior resection syndrome) 1.96, 95% confidence interval 1.1, 3.5; P = 0.02). There were no consistent differences in quality of life. Based on single studies there is limited evidence of some improvements in bowel function but no difference in quality of life after early compared to late closure of ileostomy. CONCLUSION There is some evidence for an association between low anterior resection syndrome and the use of a diverting ileostomy to protect a rectal anastomosis. Potential confounders include height of the anastomosis. Further research into the mechanisms underlying this potential association may inform methods to mitigate the harms of an ileostomy.
Collapse
Affiliation(s)
- Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Puja Sharma
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Lance Yuan
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Ian Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
16
|
Rombey T, Panagiotopoulou IG, Hind D, Fearnhead NS. Preoperative bowel stimulation prior to ileostomy closure to restore bowel function more quickly and improve postoperative outcomes: a systematic review. Colorectal Dis 2019; 21:994-1003. [PMID: 30963659 DOI: 10.1111/codi.14636] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/16/2019] [Indexed: 12/12/2022]
Abstract
AIM Closure of a diverting ileostomy following restorative surgery is often associated with significant short-term morbidity and variable long-term bowel function. The aim of this systematic review was to investigate if preoperative stimulation of the defunctioned bowel restores bowel function more quickly after ileostomy closure and improves postoperative outcomes when compared with standard preoperative care. METHOD MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov were searched for studies evaluating preoperative bowel stimulation in patients with a temporary ileostomy after low anterior resection or ileal pouch-anal anastomosis, regardless of their design, publication type or language. Study selection, data extraction and study assessment were performed by one reviewer and verified by another. Study results were synthesized narratively. The GRADE approach was used to assess the quality of evidence. RESULTS Eight studies involving a total of 267 participants were included. The studies had a moderate to high risk of bias and were of varying methodological quality. Preoperative stimulation of the defunctioned bowel reduced the time to postoperative restoration of bowel function and the length of hospital stay when compared with standard preoperative care. Other functional outcomes and postoperative complication rates were similar to those of standard preoperative care. The overall quality of evidence was very low. CONCLUSION Despite these promising early results, there is insufficient high-quality evidence to recommend routine implementation of preoperative bowel stimulation in clinical practice. Nevertheless, there is no evidence suggesting that the intervention worsens outcomes or is unsafe, paving the way for rigorous assessment of effectiveness, acceptability and cost-effectiveness within the context of well-designed clinical trials.
Collapse
Affiliation(s)
- T Rombey
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - I G Panagiotopoulou
- Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, UK
| | - D Hind
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, UK
| |
Collapse
|
17
|
Choi YJ, Kwak JM, Ha N, Lee TH, Baek SJ, Kim J, Kim SH. Clinical Outcomes of Ileostomy Closure According to Timing During Adjuvant Chemotherapy After Rectal Cancer Surgery. Ann Coloproctol 2019; 35:187-193. [PMID: 31487766 PMCID: PMC6732323 DOI: 10.3393/ac.2018.10.18.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/18/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE No guidelines exist detailing when to implement a temporary ileostomy closure in the setting of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer. The aim of this study was to evaluate the clinical and oncological outcomes of ileostomy closure during adjuvant chemotherapy in patients with curative resection of rectal cancer. METHODS This retrospective study investigated 220 patients with rectal cancer undergoing sphincter-saving surgery with protective loop ileostomy from January 2007 to August 2016. Patients were divided into 2 groups: group 1 (n = 161) who underwent stoma closure during adjuvant chemotherapy and group 2 (n = 59) who underwent stoma closure after adjuvant chemotherapy. RESULTS No significant differences were observed in operative time, blood loss, postoperative hospital stay, or postoperative complications in ileostomy closure between the 2 groups. No difference in overall survival (P = 0.959) or disease-free survival (P = 0.114) was observed between the 2 groups. CONCLUSION Ileostomy closure during adjuvant chemotherapy was clinically safe, and interruption of chemotherapy due to ileostomy closure did not change oncologic outcomes.
Collapse
Affiliation(s)
- Yoo Jin Choi
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung-Myun Kwak
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Neul Ha
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Hoon Lee
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se Jin Baek
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seon Hahn Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Faury S, Rullier E, Denost Q, Quintard B. Quality of life and fatigue among colorectal cancer survivors according to stoma status - the national VICAN survey. J Psychosoc Oncol 2019; 38:89-102. [PMID: 31304892 DOI: 10.1080/07347332.2019.1638481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: To assess colorectal cancer survivors' quality of life (QoL) and fatigue according to stoma status.Methods: In this large-scale national survey, we examined and compared QoL (SF-12) and fatigue (QLQ-C30) of colorectal cancer survivors according to stoma status and against population norms. Of the 487 colorectal cancer survivors who participated in the VICAN survey, 43 had a reversed stoma. We randomly selected 43 survivors without stoma as a comparison group.Findings: Colorectal cancer survivors had lower QoL scores compared to population norms. Fatigue affected survivors even two years after diagnosis. Participants with a reversed stoma scored lower on the physical QoL scale than participants without stoma.Conclusion: QoL and fatigue are impaired during a considerable period after cancer diagnosis and differ according to stoma status.Implications for psychosocial providers: Interventions aimed at improving QoL and fatigue for colorectal cancer survivors should be offered on a long-term basis, even two years after diagnosis.
Collapse
Affiliation(s)
- Stéphane Faury
- University Bordeaux, Laboratoire Handicap, Activité, Cognition, Santé, EA, Bordeaux, France
| | - Eric Rullier
- Department of Colorectal Surgery, Haut-Leveque Hospital, Bordeaux, France
| | - Quentin Denost
- Department of Colorectal Surgery, Haut-Leveque Hospital, Bordeaux, France
| | - Bruno Quintard
- University Bordeaux, Laboratoire Handicap, Activité, Cognition, Santé, EA, Bordeaux, France
| |
Collapse
|
19
|
Nam KH, Kim HY, Kim JH, Kang KN, Na SY, Han BH. Effects of social support and self-efficacy on the psychosocial adjustment of Korean ostomy patients. Int Wound J 2019; 16 Suppl 1:13-20. [PMID: 30793862 DOI: 10.1111/iwj.13038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022] Open
Abstract
This study aims to test which factors influence and aid the psychosocial adjustment of patients with an ostomy and to provide data for the development of programmes for the self-management of and psychosocial adjustment to intestinal stomas. A total of 150 ostomy patients were recruited between December 1, 2017 and March 26, 2018 in Korea and completed self-report questionnaires. Data of 25 participants were excluded, resulting in a sample size of 125 participants. Factors, including social support subtypes and self-efficacy, that influence the psychosocial adjustment were analysed using Cox's regression. Of the factors that influenced the adjustment groups after adjusting for time, the following subtypes of social support were found to influence the patients' adjustment: the patients' psychosocial adjustment increased by 0.4 when the level of medical staff support increased by 1 (Exp[B] = 1.04, P = 0.007), and adjustment decreased by 0.3 when the level of family support increased by 1 (Exp[B] = 0.97, P < 0.001). As medical staff support who have expertise exert more of an influence on the psychosocial adjustment of ostomy patients than self-efficacy and family support, psychosocial adjustment programmes that reflect this and nurses specialised in care for ostomy patients are required.
Collapse
Affiliation(s)
- Keum Hee Nam
- Department of Nursing, Masan University, Changwon, Republic of Korea
| | - Heui Yeoung Kim
- Department of Nursing, Dong-A University Hospital, Busan, Republic of Korea
| | - Jung Ho Kim
- Department of Nursing, Masan University, Changwon, Republic of Korea
| | - Ki-Noh Kang
- Department of Nursing, Masan University, Changwon, Republic of Korea
| | - Soo Yang Na
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Bok Hee Han
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
20
|
Tseng YL, Lin SY, Tseng HC, Wang JY, Chiu JL, Weng KT. Stress and other factors associated with colorectal cancer outpatients with temporary colostomies. Eur J Cancer Care (Engl) 2019; 28:e13054. [PMID: 30993754 DOI: 10.1111/ecc.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
This study investigated stress and other factors associated with colorectal cancer (CRC) outpatients with temporary colostomies in Taiwan. Temporary colostomies have been incorporated as a defecation alternative to maintain physical function and are accompanied by chemotherapy/radiotherapy in CRC patients. A cross-sectional study was conducted, and a convenience sampling approach was adopted to recruit 110 discharged CRC patients with temporary colostomies from a medical centre in southern Taiwan. The mean score of the Stress of Colostomy Patients Scale was 66.49 (out of 120). Demographic attributes were found to have an impact on different stress types. Stress of changes in familial and social interaction was affected by age, employment status, educational level and colostomy assistant caregiver. The stress of colostomy care was impacted by the factor of employment status, and the stress of changes of self-concept was impacted by the factors of educational level and self-perception of disease. The results provide post-operative information regarding stress and stress types among CRC patients with temporary colostomies, serve as a reference for clinical assessment, practice and care, and generate up-to-date knowledge and comprehension of learning how to live with a temporary colostomy.
Collapse
Affiliation(s)
- Yi-Ling Tseng
- Department of Nursing, Asia University, Taichung City, Taiwan
| | - Shu-Yuan Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hui-Chen Tseng
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Kaohsiung Medical University Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Jen-Li Chiu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Kai-Ting Weng
- National Cheng Kung University Hospital, Tainan City, Taiwan.,Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| |
Collapse
|
21
|
The application of defunctioning stomas after low anterior resection of rectal cancer. Surg Today 2018; 49:451-459. [DOI: 10.1007/s00595-018-1736-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/29/2018] [Indexed: 02/07/2023]
|
22
|
Beaubrun En Famille Diant L, Sordes F, Chaubard T. [Psychological impact of ostomy on the quality of life of colorectal cancer patients: Role of body image, self-esteem and anxiety]. Bull Cancer 2018; 105:573-580. [PMID: 29735158 DOI: 10.1016/j.bulcan.2018.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/17/2022]
Abstract
Surgery accounts for an important part of the therapeutic arsenal of colorectal cancer treatment. In digestive cancers, ostomy devices induce the loss of anal function and control. This medical appliance generates changes affecting all aspects of patients' lives. This study explores, on the one hand, the psychological impact of colostomy on colorectal cancer patients' quality of life and on the other hand, it analyzes the correlational links between body image, self-esteem and anxiety during the stoma. Thirty-five patients with colorectal cancer participated in the study, divided into 2 subgroups: 23 were carriers of a definitive stoma and the 12 others with a temporary stoma. All completed the Functional Assessment Cancer Therapy (FACT-C), the Body Image Scale (BIS), the State Trait Anxiety Inventory (STAI-Y) and the Self Esteem Scale (ETES). Analysis revealed the quality of life of temporary ostomates is more affected than that of the definitive ones. All three of them, body image, self-esteem and anxiety negatively affect the quality of life regardless of the type of stoma. This study highlights the prevalence of physical self-esteem for temporary ostomy; the role of a good body image and substantial emotional self-esteem for the permanent ostomy. Future studies are required to explore the underlying causes of the acceptance of this equipment and the mediating role of care devices.
Collapse
Affiliation(s)
- Laury Beaubrun En Famille Diant
- Université Toulouse, laboratoire centre d'études et de recherches en psychopathologie et psychologie de la santé (CERPPS), EA7411, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France.
| | - Florence Sordes
- Université Toulouse, laboratoire centre d'études et de recherches en psychopathologie et psychologie de la santé (CERPPS), EA7411, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
| | - Thierry Chaubard
- Centre hospitalier d'Albi, service chirurgie digestive et viscérale, 22, boulevard Sibille, 81013 Albi, France
| |
Collapse
|
23
|
Li Z, Wang K, Zhang X, Wen J. Marital status and survival in patients with rectal cancer: A population-based STROBE cohort study. Medicine (Baltimore) 2018; 97:e0637. [PMID: 29718875 PMCID: PMC6392664 DOI: 10.1097/md.0000000000010637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To examine the impact of marital status on overall survival (OS) and rectal cancer-specific survival (RCSS) for aged patients.We used the Surveillance, Epidemiology and End Results database to identify aged patients (>65 years) with early stage rectal cancer (RC) (T1-T4, N0, M0) in the United States from 2004 to 2010. Propensity score matching was conducted to avoid potential confounding factors with ratio at 1:1. We used Kaplan-Meier to compare OS and RCSS between the married patients and the unmarried, respectively. We used cox proportion hazard regressions to obtain hazard rates for OS, and proportional subdistribution hazard model was performed to calculate hazard rates for RCSS.Totally, 5196 patients were included. The married (2598 [50%]) aged patients had better crude 5-year overall survival rate (64.2% vs 57.3%, P < .001) and higher crude 5-year cancer-specific survival rate (80% vs 75.9%, P < .001) than the unmarried (2598 (50%)), respectively. In multivariate analyses, married patients had significantly lower overall death than unmarried patients (HR = 0.77, 95% CI = 0.71-0.83, P < .001), while aged married patients had no cancer-specific survival benefit versus the unmarried aged patients (HR = 0.92, 95% CI = 0.81-1.04, P = .17).Among old population, married patients with early stage RC had better OS than the unmarried, while current evidence showed that marital status might have no protective effect on cancer-specific survival.
Collapse
Affiliation(s)
- Zhuyue Li
- West China Hospital/West China School of Nursing
- Institute of Hospital Management, West China Hospital, Sichuan University, China
| | - Kang Wang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing
| | - Xuemei Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, China
| |
Collapse
|
24
|
Faury S, Rullier É, Quintard B. Image du corps, dépression et anxiété des patients atteints d’un cancer du rectum avec stomie temporaire : une étude exploratoire longitudinale. ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2016.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
Park J, Danielsen AK, Angenete E, Bock D, Marinez AC, Haglind E, Jansen JE, Skullman S, Wedin A, Rosenberg J. Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial). Br J Surg 2017; 105:244-251. [PMID: 29168881 PMCID: PMC5814870 DOI: 10.1002/bjs.10680] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/05/2017] [Accepted: 07/19/2017] [Indexed: 12/16/2022]
Abstract
Background A temporary ileostomy may reduce symptoms from anastomotic leakage after rectal cancer resection. Earlier results of the EASY trial showed that early closure of the temporary ileostomy was associated with significantly fewer postoperative complications. The aim of the present study was to compare health‐related quality of life (HRQOL) following early versus late closure of a temporary ileostomy. Methods Early closure of a temporary ileostomy (at 8–13 days) was compared with late closure (at more than 12 weeks) in a multicentre RCT (EASY) that included patients who underwent rectal resection for cancer. Inclusion of participants was made after index surgery. Exclusion criteria were signs of anastomotic leakage, diabetes mellitus, steroid treatment, and signs of postoperative complications at clinical evaluation 1–4 days after rectal resection. HRQOL was evaluated at 3, 6 and 12 months after resection using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ‐C30 and QLQ‐CR29 and Short Form 36 (SF‐36®). Results There were 112 patients available for analysis. Response rates of the questionnaires were 82–95 per cent, except for EORTC QLQ‐C30 at 12 months, to which only 54–55 per cent of the patients responded owing to an error in questionnaire distribution. There were no clinically significant differences in any questionnaire scores between the groups at 3, 6 or 12 months. Conclusion Although the randomized study found that early closure of the temporary ileostomy was associated with significantly fewer complications, this clinical advantage had no effect on the patients' HRQOL. Registration number: NCT01287637 (https://www.clinicaltrials.gov). No different after early ileostomy closure
Collapse
Affiliation(s)
- J Park
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - A K Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark
| | - E Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - D Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - A C Marinez
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - E Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - J E Jansen
- Department of Surgery, Nordsjaellands Hospital, Hillerød, Denmark
| | - S Skullman
- Department of Surgery, Skaraborgs Sjukhus, Skövde, Sweden
| | - A Wedin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - J Rosenberg
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark
| |
Collapse
|
26
|
Quelles représentations les hommes opérés d’un cancer du rectum ont-ils de la stomie temporaire ? Une étude exploratoire. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection - A Matched-Controlled Study. Dis Colon Rectum 2017; 60:1032-1040. [PMID: 28891846 DOI: 10.1097/dcr.0000000000000862] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome. OBJECTIVE The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group). DESIGN This was a matched controlled study. SETTINGS This study was conducted at multiple centers. PATIENTS The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years. MAIN OUTCOME MEASURES Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score). RESULTS The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function. LIMITATIONS This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study with a limited number of patients and with quality-of-life measurements on nonpredefined and variable intervals after surgery. CONCLUSIONS After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains. However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 66.7% of the patients in the total mesorectal excision group. See Video Abstract at http://links.lww.com/DCR/A395.
Collapse
|
28
|
Faury S, Koleck M, Foucaud J, M'Bailara K, Quintard B. Patient education interventions for colorectal cancer patients with stoma: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1807-1819. [PMID: 28602564 DOI: 10.1016/j.pec.2017.05.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills. METHODS A systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills. RESULTS Thirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate. CONCLUSIONS Patient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding. PRACTICE IMPLICATION Further education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.
Collapse
Affiliation(s)
- Stéphane Faury
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France.
| | - Michèle Koleck
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Jérôme Foucaud
- "Laboratoire Educations et Pratiques de Santé", EA 3412, Univ. Paris-13 Sorbonne, Paris Cité, 93017 Bobigny, France
| | - Katia M'Bailara
- "Laboratoire de Psychologie", EA 4139, Univ. Bordeaux, Bordeaux, F-33076, France
| | - Bruno Quintard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| |
Collapse
|
29
|
Lee HH, Shin EK, Shin HI, Yang EJ. Is WHODAS 2.0 Useful for Colorectal Cancer Survivors? Ann Rehabil Med 2017; 41:667-676. [PMID: 28971052 PMCID: PMC5608675 DOI: 10.5535/arm.2017.41.4.667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/20/2016] [Indexed: 11/12/2022] Open
Abstract
Objective To compare the disability level of colorectal cancer survivors with and without stoma by using the Korean version of the 12-item, interview-administered World Health Organization Disability Assessment Schedule 2.0 (Korean version of WHODAS 2.0). Methods This is a multicenter (five tertiary university hospitals and the Korea Ostomy Association) and cross-sectional survey. Colorectal cancer survivors with and without stoma were interviewed. Survey measured disability level using the Korean version of WHODAS 2.0 and health-related quality of life using the SF-36. Results A significant difference was observed between patients with and without a stoma in two subdomains: getting around (31.1 vs. 20.3; p=0.013) and participation in society (32.3 vs. 22.2; p=0.028). After adjusting for age, gender, and time since surgery, having a stoma was associated with severe to extreme disabilities in participation (OR=2.72, p=0.045). The Korean version of WHODAS 2.0 showed satisfactory internal consistency (r=0.96) and convergent validity. Conclusion Patients with stoma participated less in society than those without stoma. The Korean version of WHODAS 2.0 is a reliable and valid instrument for measuring disability in Korean colorectal cancer patients.
Collapse
Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun-Kyoung Shin
- Department of Social Welfare, Dankook University, Yongin, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Bundang Seoul University Hospital, Seongnam, Korea
| |
Collapse
|
30
|
Goto S, Hida K, Kawada K, Okamura R, Hasegawa S, Kyogoku T, Ota S, Adachi Y, Sakai Y. Multicenter analysis of transanal tube placement for prevention of anastomotic leak after low anterior resection. J Surg Oncol 2017; 116:989-995. [PMID: 28743178 DOI: 10.1002/jso.24760] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anastomotic leak (AL) is a serious complication of low anterior resection (LAR). This study aimed to evaluate the effect of transanal tube placement for prevention of AL. METHODS This multicenter retrospective cohort study enrolled 328 consecutive patients who underwent LAR for rectal cancer at participating hospitals from 2009 to 2014. Multivariate logistic regression was used to adjust for confounding factors. RESULTS A transanal tube was placed in 205 patients (TA group) and not placed in 123 patients (non-TA group). Symptomatic AL occurred in 36 cases (11%), with significantly higher incidence of symptomatic AL in the non-TA group than in the TA group (15% vs 8.3%, odds ratio [OR] 2.02, 95% confidence interval [CI] 1.01-4.06). After adjusting for confounding factors, multivariate analysis revealed that placement of a transanal tube could decrease the incidence of symptomatic AL (adjusted OR 0.37, 95%CI 0.15-0.91). There was no significant difference in postoperative morbidity, mortality, length of hospital stay, or local recurrence rate between the two groups. Local recurrence rate tended to be higher in patients with symptomatic AL (3/36) than in those without it (10/292). CONCLUSIONS Transanal tube placement is effective for decreasing the incidence of symptomatic AL after LAR.
Collapse
Affiliation(s)
- Saori Goto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Kawada
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Okamura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Shuichi Ota
- Department of Surgery, Saiseikai Noe Hospital, Osaka, Japan
| | - Yukito Adachi
- Department of Surgery, Saiseikai Noe Hospital, Osaka, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
31
|
Lasithiotakis K, Aghahoseini A, Alexander D. Is Early Reversal of Defunctioning Ileostomy a Shorter, Easier and Less Expensive Operation? World J Surg 2017; 40:1737-40. [PMID: 26908242 DOI: 10.1007/s00268-016-3448-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A defunctioning loop ileostomy mitigates the consequences of anastomotic leak from low rectal anastomosis but it is associated with significant morbidity. In this study, the outcome of early reversal of defunctioning ileostomy during the same admission with the primary operation was assessed. METHODS This randomized study was carried out at York Teaching Hospital during the period 2003-2007. All patients with defunctioning ileostomy were considered for an early second operation if they had an uneventful recovery and were in good general condition. Patients on steroids, at high cardiorespiratory risk and those experiencing any postoperative complication were excluded. Eligible patients with satisfactory gastrografin enema on postoperative day 6 were randomized to early versus late reversal at 6-8 weeks. Outcome measures were ease of closure as assessed by a visual analog scale by the operating surgeon, all postoperative complications, duration of the operation, total length of hospital stay and associated costs. RESULTS Thirty-nine consecutive patients were assessed for eligibility and finally 26 were included in the study. Sixteen patients underwent early reversal. The median(interquartile range (IQR)) age was 62(22) years. Early reversal was significantly superior in terms of ease of abdominal wall closure, ease of reversal (p < 0.01 each), duration of the operation (median(IQR) 20(13) vs. 40(9) min, p < 0.01) and costs of stoma care (median(IQR) 27(9) vs. 311(108) £, p < 0.01). There were no major (grade III/IV) complications in either group. Total length of hospital stay was similar between groups. CONCLUSION In carefully selected patients, early reversal of defunctioning ileostomy is feasible, technically easier and has shorter operative time which can also lead to significant cost savings.
Collapse
Affiliation(s)
- Konstantinos Lasithiotakis
- Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, North Yorkshire, YO31 8HE, UK.
| | - Assad Aghahoseini
- Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, North Yorkshire, YO31 8HE, UK
| | - David Alexander
- Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, North Yorkshire, YO31 8HE, UK
| |
Collapse
|
32
|
Cabilan CJ, Hines S. The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:517-566. [PMID: 28178025 DOI: 10.11124/jbisrir-2016003282] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients. OBJECTIVES To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis. INCLUSION CRITERIA TYPES OF PARTICIPANTS Colorectal cancer survivors aged 18 years and over. TYPES OF INTERVENTIONS Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy. TYPES OF STUDIES Pre- and post-observational and experimental studies. OUTCOMES Physical activity, ability to perform activities of daily living (functional status) and QoL. SEARCH STRATEGY CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015. METHODOLOGICAL QUALITY All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA EXTRACTION Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software. DATA SYNTHESIS The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form. RESULTS A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies. CONCLUSION In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment. IMPLICATIONS FOR PRACTICE The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors. IMPLICATIONS FOR RESEARCH The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.
Collapse
Affiliation(s)
- C J Cabilan
- 1Nursing Research Centre, Mater Misericordiae Limited, and The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence 2School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | | |
Collapse
|
33
|
Jayarajah U, Samarasekera DN. A cross-sectional study of quality of life in a cohort of enteral ostomy patients presenting to a tertiary care hospital in a developing country in South Asia. BMC Res Notes 2017; 10:75. [PMID: 28137299 PMCID: PMC5282704 DOI: 10.1186/s13104-017-2406-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
Background Enteral ostomy creation affects the quality of life (QOL) of stoma patients significantly. Studying the QOL and its determinants is important as it may help in the early identification of those with poor QOL leading to appropriate intervention. This study was aimed to assess the possible contributory factors of QOL of stoma patients. Methods A cross sectional study was conducted among 43 ostomy patients who presented for follow up at a surgical clinic of a tertiary care hospital in Sri Lanka over a period of 1 year. Relevant demographic and ostomy related data were collected using an interviewer administered questionnaire. Stoma quality of life scale (Stoma-QOL) and stoma care self-efficacy scale (SCSE) which are validated questionnaires were used to assess QOL and self-efficacy in managing stoma respectively. Associations were established using independent samples t test and Spearman’s correlation. Results The median age of the study participants was 47.5 years (range 18–83). The median follow up duration was 38 months (range 6–183). The mean overall QOL score was 53.07 ± SD 12.68. Approximately 70% of the study participants scored less than 60. Higher QOL was associated with female sex, colostomies, comfortable income and satisfactory sexual activity. Significantly lower overall QOL was found in those who reported a significant change in the style of dressing (p < 0.05), those who felt depressed (p < 0.05), and those who had thoughts of self-harm soon after surgery (p < 0.05). There was a significant positive correlation between QOL and self-efficacy (p < 0.01). Those who took longer time to learn to take care of the stoma had lower QOL (p < 0.05). Conclusions The overall QOL score was considerably low in our study. The QOL was significantly associated with self-efficacy which indicates the importance of patient education and training during follow up visits to maintain a higher QOL. Furthermore integrating with other non-surgical specialities to address multi-dimensional problems including psychosocial and sexual aspects may be helpful to achieve a better QOL.
Collapse
Affiliation(s)
- Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka
| | - Dharmabandhu N Samarasekera
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka.
| |
Collapse
|
34
|
Boyles A, Hunt S. Care and management of a stoma: maintaining peristomal skin health. ACTA ACUST UNITED AC 2016; 25:S14-S21. [DOI: 10.12968/bjon.2016.25.17.s14] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Boyles
- Nurse Specialist, Stoma Care, King's College Hospital NHS Foundation Trust
| | - Sharon Hunt
- Lead Advanced Nurse Practitioner, Wellway Medical Group, Independent Specialist Wound Care
| |
Collapse
|
35
|
Su X, Zhen L, Zhu M, Kuang Y, Qin F, Ye X, Yin X, Wang H. Determinants of self-efficacy and quality of life in patients with temporary enterostomy: a cross-sectional survey. J Clin Nurs 2016; 26:477-484. [DOI: 10.1111/jocn.13469] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Xi Su
- Guangzhou Medical University; Guangzhou China
| | - Li Zhen
- Nanfang Hospital; Southern Medical University; Guangzhou China
| | - Mulan Zhu
- Nanfang Hospital; Southern Medical University; Guangzhou China
| | - Yinyi Kuang
- The Sixth Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Fang Qin
- Southern Medical University; Guangzhou China
| | - Xinmei Ye
- The Sixth Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Xuexia Yin
- The Second Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - Huizhen Wang
- School of Nursing; Southern Medical University; Guangzhou China
| |
Collapse
|
36
|
Maguire R, Hanly P, Hyland P, Sharp L. Understanding burden in caregivers of colorectal cancer survivors: what role do patient and caregiver factors play? Eur J Cancer Care (Engl) 2016; 27. [PMID: 27271848 DOI: 10.1111/ecc.12527] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 01/22/2023]
Abstract
This study investigated how both caregiver and patient factors predict different aspects of burden in colorectal cancer caregivers. One hundred and fifty-three caregiver-survivor dyads separately provided information on patient disease and treatment-related factors, and perceived global health status (EORTC QLQ30), along with caregiver socio-demographic factors, health and care-related activities. Four multiple regression analyses were conducted to assess the influence of caregiver characteristics, patient characteristics and care-related activities on four dimensions of burden from the Caregiver Reaction Assessment scale. Caregiver characteristics significantly predicted health and financial burden (11%-13% of explained variance) with comorbidity and younger age increasing this risk. Patient health, in particular global health status and the presence of a stoma, predicted all burden scores, explaining 14%-22% of variance. Care-related activities was also a significant predictor of all burden scores, explaining an additional 5%-11% of variance, with time involved in caring the most consistent predictor. Results highlight that a combination of factors influence caregiver burden. These results may be used to identify those most at risk, allowing practitioners to deliver tailored effective support. In particular, efforts to alleviate the burden of caring on caregiver schedule may be merited, given that this was the domain in which the burden was greatest.
Collapse
Affiliation(s)
- R Maguire
- National College of Ireland, Dublin, Ireland
| | - P Hanly
- National College of Ireland, Dublin, Ireland
| | - P Hyland
- National College of Ireland, Dublin, Ireland
| | - L Sharp
- Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
37
|
Quyn A, Austin K, Young J, Badgery-Parker T, Masya L, Roberts R, Solomon M. Outcomes of pelvic exenteration for locally advanced primary rectal cancer: Overall survival and quality of life. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:823-8. [DOI: 10.1016/j.ejso.2016.02.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/22/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
|
38
|
A prospective study of sexual and urinary function before and after total mesorectal excision. Int J Colorectal Dis 2016; 31:1125-30. [PMID: 26960814 DOI: 10.1007/s00384-016-2549-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal cancer survivors' urogenital function remains limited. In this study, urogenital dysfunction after surgical rectal cancer treatment was measured and possible predisposing factors that may have an impact on the development of this disorder were discussed. METHODS One hundred eight patients undergoing curative rectal cancer surgery from January 2008 to December 2014 were questioned using questionnaires: male urinary function was assessed using the International Prostatic Symptom Score (IPSS) questionnaire, for sexual function-International Index of Erectile Function (IIEF). The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire and the Female Sexual Function Index (FSFI) were used for female urogenital function assessment prior to the operation and 6 months postoperatively. RESULTS A total of 67.0 % of male (36) and 33.0 % (18) of female patients who completed the questionnaire were included in the study. Preoperatively, male urinary dysfunction was 80.1 % and postoperatively-88.9 %. In female patients, preoperative urinary dysfunction was seen in 75.0 % patients, postoperatively-78.0 %. Erectile dysfunction was seen in 41.7 % males preoperatively and in 63.9 % postoperatively. A total of 83.3 % of female patients had sexual dysfunction preoperatively and 94 % postoperatively. CONCLUSION Sexual and urinary problems after surgery for rectal cancer are common. Preoperative genitourinary dysfunction is not uncommon in patients older than 60 years as well. Female patients reported higher rates of sexual dysfunction than males. These results point out the importance of sexual and urinary (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.
Collapse
|
39
|
Benedict C, Philip EJ, Baser RE, Carter J, Schuler TA, Jandorf L, DuHamel K, Nelson C. Body image and sexual function in women after treatment for anal and rectal cancer. Psychooncology 2015; 25:316-23. [PMID: 25974874 DOI: 10.1002/pon.3847] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/16/2015] [Accepted: 04/14/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Treatment for anal and rectal cancer (ARCa) often results in side effects that directly impact sexual functioning; however, ARCa survivors are an understudied group, and factors contributing to the sexual sequelae are not well understood. Body image problems are distressing and may further exacerbate sexual difficulties, particularly for women. This preliminary study sought to (1) describe body image problems, including sociodemographic and disease/treatment correlates, and (2) examine relations between body image and sexual function. METHODS For the baseline assessment of a larger study, 70 women completed the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire and Colorectal Cancer-specific Module, including the Body Image subscale, and Female Sexual Function Index. Pearson's correlation and multiple regression evaluated correlates of body image. Among sexually active women (n = 41), hierarchical regression examined relations between body image and sexual function domains. RESULTS Women were on average 55 years old (standard deviation = 11.6), non-Hispanic White (79%), married (57%), and employed (47%). The majority (86%) reported at least one body image problem. Younger age, lower global health status, and greater severity of symptoms related to poorer body image (p's < 0.05). Poor body image was inversely related to all aspects of sexual function (β range 0.50-0.70, p's < 0.05), except pain. The strongest association was with Female Sexual Function Index Sexual/Relationship Satisfaction. CONCLUSION These preliminary findings suggest the importance of assessing body image as a potentially modifiable target to address sexual difficulties in this understudied group. Further longitudinal research is needed to inform the development and implementation of effective interventions to improve the sexual health and well-being of female ARCa survivors.
Collapse
Affiliation(s)
- Catherine Benedict
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Errol J Philip
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeanne Carter
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tammy A Schuler
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai School, New York, NY, USA
| | - Katherine DuHamel
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Nelson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
40
|
Abstract
The frequency of ostomy surgery in Canada is not known, but it is estimated that approximately 13,000 ostomy surgeries are performed annually in Canada. This systematic review incorporates evidence for the assessment and management of colostomies, ileostomies, and urostomies, as well as the peristomal skin. The review was completed as part of a best practice guideline document generated by a task force appointed by the Registered Nurses' Association of Ontario.
Collapse
|
41
|
Averyt JC, Nishimoto PW. Psychosocial issues in colorectal cancer survivorship: the top ten questions patients may not be asking. J Gastrointest Oncol 2014; 5:395-400. [PMID: 25276412 DOI: 10.3978/j.issn.2078-6891.2014.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/01/2014] [Indexed: 12/22/2022] Open
Abstract
Advances in colorectal cancer screening and treatment have increased survivorship significantly in recent years. This has led to an increased emphasis on the need for continuing patient care long after cancer treatment is completed. Colorectal cancer survivors may face a number of psychosocial issues following treatment, including cancer-related distress, adjustment to physical changes following treatment, and challenges related to returning to work. Although there are many resources available to assist with these challenges, many patients may not seek this information from their providers during follow-up care visits. This article highlights some of the most common patient concerns related to survivorship in colorectal cancer and serves as a reminder to ask about these concerns throughout the course of treatment and follow-up care.
Collapse
Affiliation(s)
- Jennifer C Averyt
- 1 Department of Behavioral Health, 2 Department of Oncology/Hematology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Patricia W Nishimoto
- 1 Department of Behavioral Health, 2 Department of Oncology/Hematology, Tripler Army Medical Center, Honolulu, HI, USA
| |
Collapse
|
42
|
Thaysen HV, Jess P, Rasmussen PC, Nielsen MB, Laurberg S. Health-related quality of life after surgery for advanced and recurrent rectal cancer: a nationwide prospective study. Colorectal Dis 2014; 16:O223-33. [PMID: 24373460 DOI: 10.1111/codi.12551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/07/2013] [Indexed: 12/12/2022]
Abstract
AIM Advances in the treatment of rectal cancer have made it possible to perform complex rectal cancer surgery (COMP-RCS) in patients with primary advanced rectal cancer penetrating beyond the total mesorectal excision planes and in patients with locally recurrent rectal cancer. The aim of this study was to examine health-related quality of life (HRQoL) before and during the first 2 years after COMP-RCS. METHOD Between 2001 and 2008, 180 patients were treated with COMP-RCS at Aarhus University Hospital. HRQoL was assessed preoperatively and 3, 6, 12, 18 and 24 months after surgery using three questionnaires. The results were compared with those for patients treated with standard rectal cancer surgery (STAN-RCS) and with data from the general Danish population (NORM-data). RESULTS One hundred and twenty-two (68%) patients responded to the questionnaires. Of these 80 (66%) with disease-free survival for 2 years after surgery were included in the main analysis. The lowest level of functioning and the highest degree of symptoms were reported preoperatively. The majority of the HRQoL scales improved or remained stable during the first postoperative year; a decrease was observed for body image only. One year after surgery, HRQoL in patients treated with COMP-RSC was comparable to that for patients treated with STAN-RCS. Lower levels were found for physical and emotional role functioning, compared with NORM-data. CONCLUSION Patients treated with COMP-RCS experienced improvement in HRQoL in the first year after surgery. One year after surgery, HRQoL was similar to that of patients treated with STAN-RCS. Compared with NORM-data, lower levels were found for physical and emotional role functioning.
Collapse
Affiliation(s)
- H V Thaysen
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | |
Collapse
|
43
|
|
44
|
Gavaruzzi T, Giandomenico F, Del Bianco P, Lotto L, Perin A, Pucciarelli S. Quality of life after surgery for rectal cancer. Recent Results Cancer Res 2014; 203:117-149. [PMID: 25103003 DOI: 10.1007/978-3-319-08060-4_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients' health-related quality of life (HRQoL) is now considered a relevant clinical outcome. This study systematically reviewed articles published in the last 5 years, focusing on the impact of rectal cancer treatment on patients' HRQoL. Of the 477 articles retrieved, 56 met the inclusion criteria. The most frequently reported comparisons were between surgical procedures (21 articles), especially between sphincter-preserving and non-sphincter preserving surgery or between stoma and stoma-free patients (13 articles), and between multimodality therapies (11 articles). Additionally, twelve articles compared patients' and healthy controls' HRQoL as primary or secondary aim. The majority of the studies were observational (84 %), controlled (66 %), cross-sectional (54 %), prospective (100 %), with a sample of more than 100 patients (59 %), and with more than 60 % of patients treated with neoadjuvant therapy (50 %). The most frequently used instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), its colorectal cancer specific module QLQ-CR38, and the Medical Outcomes Study Short-Form 36 items questionnaire. Findings from the included articles are summarised and commented, with a special focus on the comparison between surgical treatments, between irradiated and not-irradiated patients, and between patients and the general population.
Collapse
Affiliation(s)
- Teresa Gavaruzzi
- Department of Surgical Oncological and Gastroenterological Sciences-First Surgical Clinic, University of Padova, Padua, Italy,
| | | | | | | | | | | |
Collapse
|
45
|
Anaraki F, Vafaie M, Behboo R, Maghsoodi N, Esmaeilpour S, Safaee A. Quality of life outcomes in patients living with stoma. Indian J Palliat Care 2013; 18:176-80. [PMID: 23439841 PMCID: PMC3573471 DOI: 10.4103/0973-1075.105687] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Despite efforts to maintain the intestinal tissue and treat gastrointestinal disease, a large number of patients undergo ostomy surgery each year. Using stoma reduces the patient's quality of life (QOL) greatly. Although there are approximately 3000 patients in Iran; there is little information about the impact of stoma on their QOL. Aims: The study aims to evaluate QOL of stoma patients using a special measurement tool. Settings and Design: This survey was a cross-sectional study that was conducted on 102 random samples of stoma patients. Materials and Methods: The City of Hope Quality of Life-Ostomy Questionnaire was used for collecting demographic and clinical information and evaluating QOL. Statistical Analysis Used: Univariate and multiple regression analyses were performed to identify predictors of QOL. Results: The mean score for the overall QOL for stoma patients was 7.48 ± 0.9. 70% of patients were dissatisfied with sexual activities. More than half of them reported feelings of depression following stoma surgery. Univariate analysis indicated that factors such as the type of ostomy (temporary/permanent), the underlying disease that had led to the stoma, depression, problem with location of ostomy, and change in clothing style had significant effects on overall QOL and its subscales (P < 0.05). The results of the regression analyses showed that only depression and problem with the location of ostomy were statistically significant in predicting patients’ QOL and its subscales (P < 0.05). Conclusions: The findings demonstrated that living with stoma influences the overall aspect of QOL. Education for the patients and their families is important for improving the stoma patients’ QOL. Sexual and psychological consultation may also improve patients’ QOL.
Collapse
Affiliation(s)
- Fakhrialsadat Anaraki
- Department of Surgery, Mahdieh Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
46
|
Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer. Ann Surg 2013; 256:1034-8. [PMID: 22584695 DOI: 10.1097/sla.0b013e318257d2c1] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the association between anastomotic leak and oncologic outcome after anterior resection, stratifying for defunctioning stoma. BACKGROUND It has been hypothesized that anastomotic leak predisposes rectal cancer patients to local recurrence. Many have a defunctioning stoma to reduce risk of clinically significant leakage. METHODS The records of patients undergoing low anterior resection (1991-2010) for rectal adenocarcinoma (≤15 cm from anal verge) were retrospectively analyzed using a prospectively collected colorectal database. Data (age, gender, stage, defunctioning stoma, neoadjuvant treatment, distance from anal verge, anastomotic leak) were collected. Clinical leakage was defined as anastomotic complication requiring intervention or interventional radiology within 60 days of surgery. Estimated local recurrence, overall survival, and disease-specific survival were compared using log-rank method and Cox regression analysis. RESULTS 1127 patients were included, with 5.6-year median follow-up. The incidence of clinical anastomotic leak was 3.5%. Sixteen of 677 with defunctioning stoma (2.2%) developed clinical leak; 24 of 450 without stoma (6.3%) developed leak (P = 0.005). There were no perioperative deaths among patients with clinical leakage. When stratified for defunctioning stoma, there was no association between clinical leak and local recurrence, disease-free survival, or overall survival. On multivariable analysis, when controlling for neoadjuvant therapy, distance of tumor from anal verge, defunctioning stoma, and pathologic stage, clinical leak was not associated with time to local recurrence, disease-free survival, or overall survival. CONCLUSIONS In this cohort, anastomotic leakage was not associated with risk of local recurrence. Defunctioning stoma was associated with lower incidence of clinical leakage but not with difference in oncologic outcome. Careful patient selection for defunctioning stoma helps reduce risk of clinically significant anastomotic leak.
Collapse
|
47
|
Bianchi V, Spitale A, Ortelli L, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care (QC3) in colorectal cancer. BMJ Open 2013; 3:bmjopen-2013-002818. [PMID: 23869102 PMCID: PMC3717445 DOI: 10.1136/bmjopen-2013-002818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Assessing the quality of cancer care (QoCC) has become increasingly important to providers, regulators and purchasers of care worldwide. The aim of this study was to develop evidence-based quality indicators (QIs) for colorectal cancer (CRC) to be applied in a population-based setting. DESIGN A comprehensive evidence-based literature search was performed to identify the initial list of QIs, which were then selected and developed using a two-step-modified Delphi process involving two multidisciplinary expert panels with expertise in CRC care, quality of care and epidemiology. SETTING The QIs of the clinical cancer care (QC3) population-based project, which involves all the public and private hospitals and clinics present on the territory of Canton Ticino (South Switzerland). PARTICIPANTS Ticino Cancer Registry, The Colorectal Cancer Working Group (CRC-WG) and the external academic Advisory Board (AB). MAIN OUTCOME MEASURES Set of QIs which encompass the whole diagnostic-treatment process of CRC. RESULTS Of the 149 QIs that emerged from 181 sources of literature, 104 were selected during the in-person meeting of CRC-WG. During the Delphi process, CRC-WG shortened the list to 89 QI. AB finally validated 27 QIs according to the phase of care: diagnosis (N=6), pathology (N=3), treatment (N=16) and outcome (N=2). CONCLUSIONS Using the validated Delphi methodology, including a literature review of the evidence and integration of expert opinions from local clinicians and international experts, we were able to develop a list of QIs to assess QoCC for CRC. This will hopefully guarantee feasibility of data retrieval, as well as acceptance and translation of QIs into the daily clinical practice to improve QoCC. Moreover, evidence-based selected QIs allow one to assess immediate changes and improvements in the diagnostic-therapeutic process that could be translated into a short-term benefit for patients with a possible gain both in overall and disease-free survival.
Collapse
Affiliation(s)
- Valentina Bianchi
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Alessandra Spitale
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Laura Ortelli
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Luca Mazzucchelli
- Cantonal Institute of Pathology, Clinical Pathology, Locarno, Switzerland
| | - Andrea Bordoni
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | | |
Collapse
|
48
|
Thaysen HV, Jess P, Laurberg S, Groenvold M. Validation of the Danish version of the disease specific instrument EORTC QLQ-CR38 to assess health-related quality of life in patients with colorectal cancer. Health Qual Life Outcomes 2012; 10:150. [PMID: 23241096 PMCID: PMC3541093 DOI: 10.1186/1477-7525-10-150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 12/13/2012] [Indexed: 01/07/2023] Open
Abstract
Background The European Organisation for Research and Treatment of Cancer (EORTC) quality of life colorectal questionnaire module (QLQ-CR38) was developed in 1999, and an update, the QLQ CR29 was published recently. To date the Danish version of the questionnaire has not been validated. The aim of this study was to examine the psychometric properties of the Danish version of EORTC QLQ-CR38. Methods EORTC QLQ-CR38 was administered to 190 patients with colorectal cancer in two Danish hospitals, one month after their operation. A psychometric evaluation of the questionnaire’s structure, reliability, convergent, divergent and known-groups validity was performed. Results Data from 164 (86.3%) patients were available for analysis. The Danish version of EORTC QLQ-CR38 showed satisfactory psychometric properties for the scales: body image, sexual functioning, male sexual problems and defecations problems. Suboptimal psychometric performances were found for the scales: micturition problems, symptoms of the gastrointestinal tract and weight loss. Evaluation of the psychometric properties of the scale chemotherapy side effects was limited by the low number of patients receiving chemotherapy. It was not possible to assess the psychometric properties of the scale female sexual problems and the single item sexual enjoyment due to a high number of missing values. The homogeneity of the study population made the evaluation of known-group validity difficult. Conclusions The results of this study suggest that the validity of the Danish version of EORTC QLQ-CR38 is acceptable. Furthermore, the results support the appropriateness of the updated version, the EORTC QLQ-CR29.
Collapse
Affiliation(s)
- Henriette Vind Thaysen
- Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, Aarhus C 8000, Denmark.
| | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND Patients with rectal cancer who have a temporary ostomy report good quality of life despite identifying a number of stoma-related difficulties. OBJECTIVE This study aimed to qualitatively explore the experiences of patients with rectal cancer who have a temporary ileostomy to better understand the discordant findings of previous quantitative quality-of-life studies. DESIGN/SETTING We conducted in-depth qualitative interviews with patients with stage I to III rectal cancer who underwent sphincter-preserving surgery that resulted in a temporary ileostomy. PATIENTS Twenty-six patients (54% male, median age 54) participated. Sixty-five percent had stage III disease, and 88% received neoadjuvant therapy. MAIN OUTCOME MEASURES Interviews examined preoperative expectations, overall experience, and stoma impact on quality of life. With the use of grounded theory, 2 investigators independently performed line-by-line content analysis to identify key themes. Analysis continued until data saturation. RESULTS Two major themes were identified: stoma-related difficulties and perceived response shift. Patients reported difficulty in exercise, sleep, social activities, sexuality, and clothing. Patients' perception of quality of life with a temporary stoma appears to have undergone a response shift through recalibration of their standards for measuring quality of life (internal measurement scale altered by side effects of neoadjuvant/adjuvant treatment, temporary nature of stoma, and accommodation to stoma) and reconceptualization of what "good quality of life" is (stoma difficulties were felt to be less important in comparison with cancer-related mortality). LIMITATIONS Although qualitative research is, by design, not generalizable, these data support our previous quantitative work. This convergence of findings suggests that our data may be representative. CONCLUSIONS A temporary ileostomy represents significant difficulties for patients with rectal cancer. However, because of response shift, these difficulties may not be perceived as important to overall quality of life when considered within the context of the cancer experience. Our results can inform preoperative consultations with patients who have rectal cancer to assist in aligning patient expectations of what life with a temporary ileostomy may be like.
Collapse
|
50
|
Johna S. Peritoneo-fascial suture methods for facilitating loop ileostomy mobilization. World J Surg 2012; 36:2216-7. [PMID: 22552498 DOI: 10.1007/s00268-012-1631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Samir Johna
- Southern California Permanente Medical Group, Fontana, CA, USA.
| |
Collapse
|