Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Abstract

BackgroundEnd colostomy rates following colorectal resection vary across institutions in high‐income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left‐sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg‐1 and ‐2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left‐sided colorectal resection within discrete 2‐week windows. Countries were grouped into high‐, middle‐ and low‐income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left‐sided colorectal resection were included: 113 (6·9 per cent) from low‐HDI, 254 (15·5 per cent) from middle‐HDI and 1268 (77·6 per cent) from high‐HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low‐ compared with middle‐ and high‐HDI settings. The association with colostomy use in low‐HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).ConclusionGlobal differences existed in the proportion of patients receiving end stomas after left‐sided colorectal resection based on income, which went beyond case mix alone.

Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery

“…From previous work we have been able to demonstrate that trainees are highly motivated to participate in research when their efforts are recognised and PubMed citable [ 12 ]. This has been echoed by global collaborative studies such as those run by GlobalSurg [ 13 ] ( https://globalsurg.org/ ), conducted under a single author name and listing all those individuals who have contributed as co-authors.…”

Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer

“…Furthermore, elderly patients are at higher risk for death in case of postoperative complications because of the impaired functional reserve [ 13 , 14 ]. These risks usually impact the surgeon’s decision on the surgical plan, especially for elderly patients with left-sided CRC where Hartmann’s procedure may be selected instead of primary anastomosis [ 15 , 16 ]. Further, advanced age had initially been viewed as a relative contraindication to laparoscopic surgery [ 17 ], and minimally invasive surgery (MIS) is still underutilized in the elderly [ 18 ].…”

Laparoscopic PME with colorectal anstomosis with transanal control – A video vignette

“…After multidisciplinary discussion the patient underwent seven cycles of FOLFOX NAC. CT performed at the end of NAC showed a marked reduction in right colon cancer and a reduction in the number and size of pericolic and intermediate lymph nodes.Then we performed a laparoscopic right mesocolectomy with intracorporeal anastomosis[8,9]. The operating time was 5 h. There were no perioperative complications.…”