Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma

O’Leary, D; Fide, C J; Foy, Chris; Lucarotti, M. E.

doi:10.1046/j.0007-1323.2001.01862.x

Cited by 148 publications

(105 citation statements)

References 24 publications

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“…Two have favored loop transverse colostomy 12,14 , and two have recommended ileostomy 11,15 . In other non-randomized studies, construction of a loop ileostomy has been the preference, in the absence of any hard evidence favoring loop colostomy 16,17,18 . Both types of stoma present high complication rates, with considerable mortality rates 19 .…”

Section: Introductionmentioning

confidence: 99%

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

et al. 2008

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Purpose:The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. Methods: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. Results: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I 2 = 0% for the heterogeneity test. Conclusions: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials. Key words: Ileostomy. Colostomy. Colorectal surgery. Systematic review. Meta-analysis. RESUMO Objetivo:A controvérsia entre ileostomia em alça ou colostomia em alça como a melhor forma para a descompressão temporária da anastomose colorretal motivou a realização desta revisão. Métodos: Cinco ensaios clínicos casualizados foram incluídos com 334 pacientes: 168 no grupo de ileostomia e 166 no grupo de colostomia. Os resultados analisaram: 1. Mortalidade; 2. Infecção da ferida; 3. Tempo de formação do estoma; 4. Tempo de fechamento do estoma; 5. Intervalo de tempo entre a formação e o fechamento do estoma; 6. Prolapso do estoma; 7. Retração do estoma; 8. Hérnia parastomal; 9. Fistula parastomal; 10. Estenose; 11. Necrose; 12. Irritação de pele; 13. Íleo; 14. Fístula entérica; 15. Reoperação; 16. Adaptação do paciente; 17. Tempo de internação hospitalar; 18. Deiscência da anastomose colorretal; 19. Hérnia de Incisional; 20. Obstrução intestinal pós-operatória. Resultados: Prolapso do estoma: p = 0.00001, mas com heterogeneidade estatística; a análise de sensibilidade foi aplicada excluindo os estudos que incluíram cirurgias de emergência: p = 0.02 e teste de heterogeneidade: I 2 =0%. Conclusões: Os resultados encontrados não foram estatística ou clinicamente significantes, exceto prolapso do estoma. A melhor evidência para a escolha entre ileostomia em alça ou colostomia em alça necessita de maior número de ensaios clínicos.

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Section: Introductionmentioning

confidence: 99%

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

et al. 2008

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“…Temporary loop ileostomy remains a major psychological handicap and causes significant physical stress, leading to an adverse effect on quality of life 9,10 . Furthermore, patients with rectal cancer are increasingly being offered postoperative adjuvant therapy, which creates uncertainty about the timing of stoma closure 11 .…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Alvès

Panís

Lelong

et al. 2008

British Journal of Surgery

153

162

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Background: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma.Methods: Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection.Results: Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0·254). Overall surgical complication (both 15 per cent; P = 1·000) and reoperation (both 8 per cent; P = 1·000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0·007). Small bowel obstruction (3 versus 16 per cent; P = 0·002) and medical complications (5 versus 15 per cent; P = 0·021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6-59) versus 18 (9-262) days; P = 0·013). Conclusion:Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. Registration number: NCT00428636 (http://www.clinicaltrials.gov).

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“…At 12 months, the prevalence of symptoms had decreased. Gastrointestinal symptoms can also appear after stoma reversal, and this has been described as the principle matter of concern for patients [28,29]. The deterioration in gastrointestinal function reported in the present study after six months could be a sign of LARS, whether patients had an end-to-end anastomosis or a stoma that had been reversed.…”

Section: Time Of Measurementmentioning

confidence: 50%

Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study

Jakobsson

Idvall

Wann-Hansson

2014

Int J Colorectal Dis

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1 AbstractPurpose. The concept of enhanced recovery after surgery (ERAS) is a modern regime of care, and numerous studies have proved its beneficial impact on recovery after colorectal surgery. However, little is known about patients' continuing recovery after discharge. Therefore, the purpose of this study was to describe patientreported recovery after colorectal cancer surgery in the context of ERAS from the day of discharge until one month and six months after surgery.Method. Assessments were made at discharge, at one month, and at six months after surgery using the questionnaire Postoperative Recovery Profile (PRP). In all, 119 patients recovering from abdominoperineal resection, rectal resection, or colonic resection completed all three assessments.Results. The global score of recovery showed that no patient experienced being fully recovered at discharge. After rectal resection, patients frequently reported being not at all recovered. One month after surgery, patients recovering from colonic resection reported significant improvements regarding 11 of 17 questionnaire items, whereas abdominoperineal resection patients reported no significant improvements regarding any item. Instead, significantly higher levels of problems were reported in the items fatigue, muscle weakness, and feeling down. Rectal resection patients reported significant improvements between one and six months after surgery regarding 7 of 19 items. However, the item gastrointestinal function distinguished, as patients reported significant deterioration towards higher levels of problems six months after surgery.Conclusion. This study elucidates the difference between groups of colorectal patients and the diverse patterns of their recovery, implying different needs in terms of prolonged support after discharge.

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Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma

Abstract: LAR with TME and temporary loop ileostomy for rectal cancer results in a long total hospital stay and impairs aspects of HRQOL. Prompt stoma closure should be a priority in these patients.

Cited by 148 publications

References 24 publications

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study

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