Impact of a Diverting Stoma in an Enhanced Recovery Programme for Rectal Cancer

Gumbau, Verónica; García-Armengol, Juan; Salvador-Martínez, Antonio; Ivorra, Purificación; García-Coret, María José; García-Rodríguez, Vicente; Roig, José V.

doi:10.1016/j.cireng.2014.03.012

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…It is clear that, in contemporary practice, the majority of patients undergoing anterior resection for rectal cancer receive an initial defunctioning stoma, making the practice almost routine in many centres [1][2][3]. Despite these high rates of defunctioning stoma use, there are very few studies comparing overall complication rates in patients who are managed with a defunctioning stoma to those without [8][9][10], and few of the RCTs or non-randomised studies examining the effect of defunctioning stomas on anastomotic leak report overall complications [18,27,29]. Evidence of the effect of forming a defunctioning stoma on overall short-term morbidity, which is currently lacking, may well influence a surgeon's decision to create a stoma during anterior resection.…”

Section: Discussionmentioning

confidence: 99%

“…Overall post-operative complications are rarely reported in these studies. There are very few studies specifically comparing the overall complications in patients managed with and without defunctioning stomas [8][9][10] and these generally involve small numbers of patients and report conflicting results. Despite the paucity of comparative studies, a number of case series suggest that there is significant short-term morbidity associated with defunctioning stomas [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Defunctioning Stomas Result in Significantly More Short‐Term Complications Following Low Anterior Resection for Rectal Cancer

et al. 2018

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BackgroundStudies suggest that defunctioning stomas reduce the rate of anastomotic leakage and urgent reoperations after anterior resection. Although the magnitude of benefit appears to be limited, there has been a trend in recent years towards routinely creating defunctioning stomas. However, little is known about post-operative complication rates in patients with and without a defunctioning stoma. We compared overall short-term post-operative complications after low anterior resection in patients managed with a defunctioning stoma to those managed without a stoma.MethodsA retrospective cohort study of patients undergoing elective low anterior resection of the rectum for rectal cancer. The primary outcome was overall 90-day post-operative complications.ResultsTwo hundred and three patients met the inclusion criteria for low anterior resection. One hundred and forty (69%) had a primary defunctioning stoma created. 45% received neoadjuvant radiotherapy. Patients with a defunctioning stoma had significantly more complications (57.1 vs 34.9%, p = 0.003), were more likely to suffer multiple complications (17.9 vs 3.2%, p < 0.004) and had longer hospital stays (13.0 vs 6.9 days, p = 0.005) than those without a stoma. 19% experienced a stoma-related complication, 56% still had a stoma 1 year after their surgery, and 26% were left with a stoma at their last follow-up. Anastomotic leak rates were similar but there was a significantly higher reoperation rate among patients managed without a defunctioning stoma.ConclusionPatients selected to have a defunctioning stoma had an absolute increase of 22% in overall post-operative complications compared to those managed without a stoma. These findings support the more selective use of defunctioning stomas.Study registrationRegistered at www.researchregistry.com (UIN: researchregistry3412).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Defunctioning Stomas Result in Significantly More Short‐Term Complications Following Low Anterior Resection for Rectal Cancer

et al. 2018

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“…6,7 However, other publications have not confirmed this factor. For example, Gumbao and colleagues 8 found no differences in postoperative complications or hospital length of stay including readmission between patients who underwent anterior rectal resection and anastomosis with or without a diverting ileostomy, in the setting of a multidisciplinary team and a multimodal rehabilitation program.…”

Section: Introductionmentioning

confidence: 99%

Influence of Preoperative Educational Intervention for Patients Undergoing Fecal Ostomy Surgery

García-Cabrera,

de la Portilla de Juan,

Navarro-Morales

et al. 2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: This aim of this study was to compare the impact on hospital stay and short-term overall complications prior to and following the introduction of an outpatient preoperative ostomy education program to an existing inpatient ostomy education program. DESIGN: A comparison cohort study. SUBJECTS AND SETTING: One hundred thirty-eight consecutive patients undergoing ostomy surgery were included. One group (n = 65, 47%) was given an experimental preoperative ostomy education intervention, along with standard care including a postoperative educational intervention during the initial hospital course. A second group (n = 73, 53%) received the same standardized education in the postoperative period. Data were collected from a single tertiary center located in Seville, Spain, during a 12-month period between July 2014 and June 2015. METHODS: Data were collected in 2 phases. Data from participants undergoing postoperative (standard) education were collected retrospectively. Data for the group receiving preoperative education were collective prospectively. Outcome variables were postoperative length of stay, surgical complications (severity was assessed by the Clavien-Dindo grading system), subsequent interventions, and readmission rates. RESULTS: Analysis indicated no differences between the average length of postoperative hospital stay (12.32 days in the preoperative education group vs 12.76 days in the postoperative education group, P = .401). In contrast, overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group (P = .027, P = .047, and P = .046, respectively). CONCLUSIONS: Delivering a standardized educational intervention during the preoperative period versus postoperative education delivery during the ostomy surgery hospital course did not reduce length of stay. Analysis indicated that overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group but we hypothesize that intervening factors may have influenced these outcomes.

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Comment on “Does a Combination of Laparoscopic Approach and Full Fast Track Multimodal Management Decrease Postoperative Morbidity?”

Jiang

Kehlet

et al. 2019

Annals of Surgery

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Impact of a Diverting Stoma in an Enhanced Recovery Programme for Rectal Cancer

Cited by 4 publications

References 29 publications

Defunctioning Stomas Result in Significantly More Short‐Term Complications Following Low Anterior Resection for Rectal Cancer

Defunctioning Stomas Result in Significantly More Short‐Term Complications Following Low Anterior Resection for Rectal Cancer

Influence of Preoperative Educational Intervention for Patients Undergoing Fecal Ostomy Surgery

Comment on “Does a Combination of Laparoscopic Approach and Full Fast Track Multimodal Management Decrease Postoperative Morbidity?”

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