A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network

Parmar, Kat; Zammit, M.; Smith, A. N.; Kenyon, D; Lees, Nicholas P.; Manchester, Greater

doi:10.1111/j.1463-1318.2010.02325.x

Cited by 116 publications

(129 citation statements)

References 12 publications

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“…4,11,12 as with traditional complication rates, rates of problematic ostomies have also been shown to vary by hospital unit, suggesting the potential for quality improvement. 4,11 Postoperative management problems are exacerbated by poorly constructed or sited ostomies, complications following surgery, and inadequate perioperative care. the purpose of this clinical practice guideline is to give guidance to surgeons and other health care providers in an effort to improve the quality of care and outcomes for patients undergoing ostomy surgery.…”

Section: Statement Of the Problemmentioning

confidence: 95%

“…2 however, the true morbidity of ostomy surgery includes significant negative effects on quality of life, plus longer-term morbidity related to ostomy care. [3][4][5][6][7][8][9][10] up to half of ostomies are "problematic," presenting management problems including skin irritation and pouching difficulties that require prolonged medical care and result in increased health care costs (prolonged length of stay and/ or increased need for outpatient care). 4,11,12 as with traditional complication rates, rates of problematic ostomies have also been shown to vary by hospital unit, suggesting the potential for quality improvement.…”

Section: Statement Of the Problemmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10] up to half of ostomies are "problematic," presenting management problems including skin irritation and pouching difficulties that require prolonged medical care and result in increased health care costs (prolonged length of stay and/ or increased need for outpatient care). 4,11,12 as with traditional complication rates, rates of problematic ostomies have also been shown to vary by hospital unit, suggesting the potential for quality improvement. 4,11 Postoperative management problems are exacerbated by poorly constructed or sited ostomies, complications following surgery, and inadequate perioperative care.…”

Section: Statement Of the Problemmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Practice Guidelines for Ostomy Surgery

Hendren

Hammond

Glasgow

et al. 2015

Diseases of the Colon &Amp; Rectum

144

166

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Section: Statement Of the Problemmentioning

confidence: 95%

Section: Statement Of the Problemmentioning

confidence: 99%

Section: Statement Of the Problemmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guidelines for Ostomy Surgery

Hendren

Hammond

Glasgow

et al. 2015

Diseases of the Colon &Amp; Rectum

144

166

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“…Patients undergoing an emergency procedure were more likely to have a problematic stoma. Another audit, too, revealed emergency surgery as a significant risk factor for stoma complications after colorectal cancer surgery [10] . An at least theoretical approach to circumvent the emergency operation and its complications is the bridging of the obstruction with a stent.…”

Section: Commentary On Hot Topicsmentioning

confidence: 99%

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

Grundmann¹

2013

WJGS

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There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann's procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial. COMMENTARY ON HOT TOPICSThere is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. In a multicenter German observation study, out of 15 911 patients with cancer of the left colon a total of 743 patients (4.7%) underwent emergency surgery, performed as a radical resection. In 57.9% (n = 430) a one-stage operation, in 11.7% (n = 87) a primary anastomosis with protective stoma, and in 30.4% (n = 226) Hartmann's procedure (HP) were performed [1] . The morbidity and hospital mortality rates (overall hospital mortality, 7.7%, n = 57) did not differ significantly between the groups. With comparable mortality, HP was recommended for high risk patients in the emergency situation. On the basis of a literature search, Trompetas [2] came to a similar conclusion: primary resection with end colostomy (HP) is considered the safest option in malignant left-sided colonic obstruction. The main advantages are that there is no risk of anastomotic dehiscence and the operation can be performed by less experienced and non-specialist surgeons. The main disadvantages of HP are the need for a second major operation to reverse the colostomy, and the fact that 40%-60% of patients do

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“…Most data are adapted from studies in patients undergoing colostomy and ileostomy, in whom issues such as obesity, malnutrition, increasing age, history of radiation exposure, and increased intra-abdominal pressure from chronic coughing, constipation, or ascites, have been cited as potential risk factors. 2,[7][8][9][10] Technical factors, such as the type of stoma created, the size and location of the abdominal wall defect through which the stoma is formed, and preoperative marking of the stoma site by a wound-ostomy nurse may also impact the risk of PH formation. [11][12][13][14] The aim of this study was to determine the prevalence and risk factors for developing a PH following RC and conduit diversion for bladder cancer.…”

Section: Introductionmentioning

confidence: 99%

1759 Risk Factors for the Development of Parastomal Hernia After Radical Cystectomy

et al. 2013

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Purpose-Parastomal hernia (PH) is a frequent complication from stoma formation after radical cystectomy (RC). We sought to determine the prevalence and risk factors for developing PH following RC.Material and Methods-Retrospective study of 433 consecutive patients who underwent open RC and ileal conduit between 2006-2010. Postoperative cross-sectional imaging studies performed for routine oncologic follow-up (n=1736) were evaluated for PH, defined as radiographic evidence of protrusion of abdominal contents through the abdominal wall defect created by forming the stoma. Univariable and multivariable Cox regression analyses were used to determine clinical and surgical factors associated with PH.Results-Complete data were available for 386 patients with radiographic PH occurring in 136. The risk of developing a PH was 27% (95% CI 22-33%) and 48% (95% CI 42-55%) at 1 and 2 years. Clinical diagnosis of PH was documented in 93 patients and 37 were symptomatic. Of 16 patients with clinical PH referred for repair, 8 had surgery. On multivariable analysis, female gender (HR=2.25, 95%CI 1.58-3.21; p<0.0001), higher BMI (HR=1.08 per unit increase 95%CI 1.05-1.12; p<0.0001), and lower preoperative albumin (HR=0.43 per g/dl, 95%CI 0.25-0.75; p=0.003) were significantly associated with PH.Conclusions-The overall risk of radiographic evidence of PH approached 50% at 2 years. Female gender, higher BMI, and lower preoperative albumin were most associated with developing PH. Identifying those at greatest risk may allow for prospective surgical maneuvers at the time of initial surgery, such as placement of prophylactic mesh in selected patients, to prevent the occurrence of PH.

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A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network

Abstract: Stoma type, stoma length, body mass index, emergency surgery and lack of preoperative marking were significant risk factors. Overall complication rates compare favourably with other studies.

Cited by 116 publications

References 12 publications

Clinical Practice Guidelines for Ostomy Surgery

Clinical Practice Guidelines for Ostomy Surgery

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

1759 Risk Factors for the Development of Parastomal Hernia After Radical Cystectomy

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