TY - JOUR
T1 - Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer
T2 - why aren’t we doing it?
AU - Caminsky, Natasha G.
AU - Moon, Jeongyoon
AU - Morin, Nancy
AU - Alavi, Karim
AU - Auer, Rebecca C.
AU - Bordeianou, Liliana G.
AU - Chadi, Sami A.
AU - Drolet, Sébastien
AU - Ghuman, Amandeep
AU - Liberman, Alexander Sender
AU - MacLean, Tony
AU - Paquette, Ian M.
AU - Park, Jason
AU - Patel, Sunil
AU - Steele, Scott R.
AU - Sylla, Patricia
AU - Wexner, Steven D.
AU - Vasilevsky, Carol Ann
AU - Rajabiyazdi, Fateme
AU - Boutros, Marylise
N1 - Funding Information:
We would like to acknowledge the help of Georgia Rigas, our research assistant, who helped consent and interview patients and transcribed most of the surgeon interviews. We would also like to thank Aashiyan Singh, who helped with ethics submission and revision, and Dan Marinescu who performed the statistical analysis.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023/1
Y1 - 2023/1
N2 - Background: Early ileostomy closure (EIC), ≤ 2 weeks from creation, is a relatively new practice. Multiple studies have demonstrated that this approach is safe, feasible, and cost-effective. Despite the demonstrated benefits, this is neither routine practice, nor has it been studied, in North America. This study aimed to assess patient and surgeon perspectives about EIC. Methods: A mixed-methods, cross-sectional study of patients and surgeons was performed. Rectal cancer survivors from a single institution who underwent restorative proctectomy with diverting loop ileostomy and subsequent closure within the last 5 years were contacted. North American surgeons with high rectal cancer volumes (> 20 cases/year) were included. Surveys (patients) and semi-structured interviews (surgeons) were conducted. Analysis employed descriptive statistics and thematic analysis, respectively. Results: Forty-eight patients were surveyed (mean age 65.1 ± 11.8 years; 54.2% male). Stoma closure occurred after a median of 7.7 months (IQR 4.8–10.9) and 50.0% (24) found it “difficult” or “very difficult” to live with their stoma. Patients considered improvement in quality of life and quicker return to normal function the most important advantages of EIC, whereas the idea of two operations in two weeks being too taxing on the body was deemed the biggest disadvantage. Most patients (35, 72.9%) would have opted for EIC. Surgeon interviews (15) revealed 4 overarching themes: (1) there are many benefits to EIC; (2) specific patient characteristics would make EIC an appropriate option; (3) many barriers to implementing EIC exist; and (4) many logistical hurdles need to be addressed for successful implementation. Most surgeons (12, 80.0%) would “definitely want to participate” in a North American randomized-controlled trial (RCT) on EIC for rectal cancer patients. Conclusions: Implementing EIC poses many logistical challenges. Both patients and surgeons are interested in further exploring EIC and believe it warrants a North American RCT to motivate a change in practice. Graphical abstract: [Figure not available: see fulltext.]
AB - Background: Early ileostomy closure (EIC), ≤ 2 weeks from creation, is a relatively new practice. Multiple studies have demonstrated that this approach is safe, feasible, and cost-effective. Despite the demonstrated benefits, this is neither routine practice, nor has it been studied, in North America. This study aimed to assess patient and surgeon perspectives about EIC. Methods: A mixed-methods, cross-sectional study of patients and surgeons was performed. Rectal cancer survivors from a single institution who underwent restorative proctectomy with diverting loop ileostomy and subsequent closure within the last 5 years were contacted. North American surgeons with high rectal cancer volumes (> 20 cases/year) were included. Surveys (patients) and semi-structured interviews (surgeons) were conducted. Analysis employed descriptive statistics and thematic analysis, respectively. Results: Forty-eight patients were surveyed (mean age 65.1 ± 11.8 years; 54.2% male). Stoma closure occurred after a median of 7.7 months (IQR 4.8–10.9) and 50.0% (24) found it “difficult” or “very difficult” to live with their stoma. Patients considered improvement in quality of life and quicker return to normal function the most important advantages of EIC, whereas the idea of two operations in two weeks being too taxing on the body was deemed the biggest disadvantage. Most patients (35, 72.9%) would have opted for EIC. Surgeon interviews (15) revealed 4 overarching themes: (1) there are many benefits to EIC; (2) specific patient characteristics would make EIC an appropriate option; (3) many barriers to implementing EIC exist; and (4) many logistical hurdles need to be addressed for successful implementation. Most surgeons (12, 80.0%) would “definitely want to participate” in a North American randomized-controlled trial (RCT) on EIC for rectal cancer patients. Conclusions: Implementing EIC poses many logistical challenges. Both patients and surgeons are interested in further exploring EIC and believe it warrants a North American RCT to motivate a change in practice. Graphical abstract: [Figure not available: see fulltext.]
KW - Colorectal surgery
KW - Early stoma closure
KW - Quality of life
KW - Survey study
KW - Thematic analysis
UR - http://www.scopus.com/inward/record.url?scp=85139439824&partnerID=8YFLogxK
U2 - 10.1007/s00464-022-09580-5
DO - 10.1007/s00464-022-09580-5
M3 - Article
C2 - 36195816
AN - SCOPUS:85139439824
SN - 0930-2794
VL - 37
SP - 669
EP - 682
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
IS - 1
ER -