Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective?

被引：15

作者：

Balla, Andrea ^{[1
]}

Saraceno, Federica ^{[1
,2
]}

Rullo, Marika ^{[3
]}

Morales-Conde, Salvador ^{[4
]}

Targarona Soler, Eduardo M. ^{[5
]}

Di Saverio, Salomone ^{[6
]}

Guerrieri, Mario ^{[7
]}

Lepiane, Pasquale ^{[1
]}

Di Lorenzo, Nicola ^{[2
]}

Adamina, Michel ^{[8
,9
]}

Alarcon, Isaias ^{[5
]}

Arezzo, Alberto ^{[10
]}

Rodriguez, Jesus Bollo ^{[11
]}

Boni, Luigi ^{[12
]}

Biondo, Sebastiano ^{[12
]}

Carrano, Francesco Maria ^{[2
]}

Chand, Manish ^{[13
]}

Jenkins, John T. ^{[14
]}

Davies, Justin ^{[15
,16
]}

Rivilla, Salvadora Delgado ^{[17
]}

Delrio, Paolo ^{[18
]}

Elmore, Ugo ^{[19
]}

Espin-Basany, Eloy ^{[20
]}

Fichera, Alessandro ^{[21
]}

Lorente, Blas Flor ^{[22
]}

Francis, Nader ^{[23
]}

Ruiz, Marcos Gomez ^{[24
,25
]}

Hahnloser, Dieter ^{[26
]}

Licardie, Eugenio ^{[27
]}

Martinez, Carmen ^{[5
]}

Ortenzi, Monica ^{[7
]}

Panis, Yves ^{[28
]}

Idoate, Carlos Pastor ^{[29
]}

Paganini, Alessandro M. ^{[30
]}

Pera, Miguel ^{[31
]}

Perinotti, Roberto ^{[32
]}

Popowich, Daniel A. ^{[33
]}

Rockall, Timothy ^{[34
]}

Rosati, Riccardo ^{[19
]}

Sartori, Alberto ^{[35
]}

Scoglio, Daniele ^{[36
]}

Shalaby, Mostafa ^{[37
]}

Fernandez, Vicente Simo ^{[38
]}

Smart, Neil J. ^{[39
]}

Spinelli, Antonino ^{[40
,41
]}

Sylla, Patricia ^{[42
]}

Tanis, Pieter J. ^{[43
,44
]}

Valdes-Hernandez, Javier ^{[45
]}

Wexner, Steven D. ^{[46
]}

Sileri, Pierpaolo ^{[19
]}

机构：

[1] Hosp San Paolo, UOC Gen & Minimally Invas Surg, Largo Donatori del Sangue 1, I-00053 Rome, Italy

[2] Univ Roma Tor Vergata, Dept Gen Surg, PhD Program Appl Med Surg Sci, Rome, Italy

[3] Univ Siena, Dept Social Polit & Cognit Sci, Siena, Italy

[4] Univ Seville, Univ Hosp Virgen del Rocio, Dept Gen & Digest Surg, Unit Innovat Minimally Invas Surg, Seville, Spain

[5] Univ Autonoma Barcelona, Gen & Digest Surg Unit, Hosp Santa Creu & St Pau, Barcelona, Spain

[6] San Benedetto del Tronto Gen Hosp, ASUR Marche 5, San Benedetto Tronto, Italy

[7] Univ Politecn Marche, Dept Gen Surg, Ancona, Italy

[8] Univ Basel, Kantonsspital Winterthur, Dept Surg, Basel, Switzerland

[9] Univ Basel, Fac Med, Basel, Switzerland

[10] Univ Torino, Dept Surg Sci, Turin, Italy

[11] Fdn IRCCS Ca Granda Osped Maggiore Policlin Milan, Dept Surg, Milan, Italy

[12] Bellvitge Univ Hosp, Barcelona, Spain

[13] UCL, Div Surg & Intervent Sci, London, England

[14] North West London NHS Trust, Dept Colorectal Surg, St Marks Hosp, London, England

[15] Addenbrookes Hosp, Cambridge Colorectal Unit, Cambridge, England

[16] Univ Cambridge, Cambridge, England

[17] Hosp Univ MutuaTerrassa, Dept Gen Surg, Barcelona, Spain

[18] IRCCS Fdn Pascale, Ist Nazl Tumori, Colorectal Surg Oncol, Naples, Italy

[19] Univ Vita Salute San Raffaele, San Raffaele Hosp IRCCS, Dept Gastrointestinal Surg, Milan, Italy

[20] Univ Autonoma Barcelona, Hosp Valle Hebron, Colorectal Surg Unit, Barcelona, Spain

[21] Baylor Univ, Med Ctr, Dept Surg, Div Colorectal Surg, Dallas, TX 75246 USA

[22] La Fe Univ Hosp, Digest Surg Dept, Valencia, Spain

[23] Yeovil Dist Hosp NHS Fdn Trust, Dept Gen Surg, Higher Kingston, Yeovil, England

[24] Hosp Univ Marques de Valdecilla, Colorectal Surg Unit, Santander, Spain

[25] IDIVAL, Valdecilla Biomed Res Inst, Santander, Spain

[26] Univ Hosp Lausanne, Lausanne, Switzerland

[27] Hosp Quironsalud Sagrad Corazon, Unit Gen & Digest Surg, Seville, Spain

[28] Hop Beaujon, Dept Colorectal Surg, Clichy, France

[29] Univ Clin Navarre, Dept Gen Surg, Div Colorectal Surg, Madrid, Spain

[30] Sapienza Univ Rome, Dept Gen Surg & Surg Specialties Paride Stefanini, Rome, Italy

[31] Hosp del Mar Med Res Inst IMIM, Hosp del Mar, Barcelona, Spain

[32] Biella Hosp, Dept Gen Surg, SS Colo Rectal & Proctol Surg, Ponderano, Biella, Italy

[33] St Francis Hosp, Roslyn, NY USA

[34] Royal Surrey NHS Fdn Trust, Gen Surg, Guildford, Surrey, England

[35] San Valentino Hosp, Dept Gen & Emergency Surg, Treviso, Italy

[36] San Dona di Piave Gen Hosp, Dept Gen Surg, AULSS Veneto Orientale 4, San Dona Di Piave, Italy

[37] Mansoura Univ, Mansoura Univ Hosp, Dept Gen Surg, Colorectal Surg Unit, Mansoura, Egypt

[38] Rio Hortega Hosp, Coloproctol Unit, Valladolid, Spain

[39] Exeter Hosp, Exeter, Devon, England

[40] Humanitas Univ, Dept Biomed Sci, Milan, Italy

[41] IRCCS Humanitas Res Hosp, Div Colon & Rectal Surg, Milan, Italy

[42] Mt Sinai Hosp, New York, NY 10029 USA

[43] Univ Amsterdam, Canc Ctr Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands

[44] Erasmus MC, Dept Surg Oncol & Gastrointestinal Surg, Rotterdam, Netherlands

[45] Virgen Macarena Univ Hosp, Colorectal Surg Unit, Gen & Digest Surg Unit, Seville, Spain

[46] Cleveland Clin Florida, Dept Colorectal Surg, Weston, FL USA

来源：

COLORECTAL DISEASE | 2023年 / 25卷 / 04期

关键词：

Adenocarcinoma; Anterior resection of the rectum; Decision-making process; Defunctioning stoma; Protective ileostomy; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; QUALITY-OF-LIFE; ANASTOMOTIC LEAKAGE; RISK-FACTORS; DEFUNCTIONING ILEOSTOMY; COLORECTAL-CANCER; METAANALYSIS; SURGERY; MULTICENTER; STOMAS;

D O I：

10.1111/codi.16454

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

AimThe choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. MethodFifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. ResultsOverall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). ConclusionThe indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.

引用

页码：647 / 659

页数：13

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