Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective?
Por:
Balla, A, Saraceno, F, Rullo, M, Morales-Conde, S, Soler, EMT, Di Saverio, S, Guerrieri, M, Lepiane, P, Di Lorenzo, N, Adamina, M, Alarcon, I, Arezzo, A, Rodriguez, JB, Boni, L, Biondo, S, Carrano, FM, Chand, M, Jenkins, JT, Davies, J, Rivilla, SD, Delrio, P, Elmore, U, Espin-Basany, E, Fichera, A, Lorente, BF, Francis, N, Ruiz, MG, Hahnloser, D, Licardie, E, Martinez, C, Ortenzi, M, Panis, Y, Idoate, CP, Paganini, AM, Pera, M, Perinotti, R, Popowich, DA, Rockall, T, Rosati, R, Sartori, A, Scoglio, D, Shalaby, M, Fernandez, VS, Smart, NJ, Spinelli, A, Sylla, P, Tanis, PJ, Valdes-Hernandez, J, Wexner, SD, Sileri, P
Publicada:
1 abr 2023
Ahead of Print:
1 dic 2022
Resumen:
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.
Filiaciones:
Balla, A:
Hosp San Paolo, UOC Gen & Minimally Invas Surg, Largo Donatori del Sangue 1, I-00053 Rome, Italy
Saraceno, F:
Hosp San Paolo, UOC Gen & Minimally Invas Surg, Largo Donatori del Sangue 1, I-00053 Rome, Italy
Univ Roma Tor Vergata, Dept Gen Surg, PhD Program Appl Med Surg Sci, Rome, Italy
Rullo, M:
Univ Siena, Dept Social Polit & Cognit Sci, Siena, Italy
Morales-Conde, S:
Univ Seville, Univ Hosp Virgen del Rocio, Dept Gen & Digest Surg, Unit Innovat Minimally Invas Surg, Seville, Spain
Soler, EMT:
Univ Autonoma Barcelona, Gen & Digest Surg Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Di Saverio, S:
San Benedetto del Tronto Gen Hosp, ASUR Marche 5, San Benedetto Tronto, Italy
Guerrieri, M:
Univ Politecn Marche, Dept Gen Surg, Ancona, Italy
Lepiane, P:
Hosp San Paolo, UOC Gen & Minimally Invas Surg, Largo Donatori del Sangue 1, I-00053 Rome, Italy
Di Lorenzo, N:
Univ Roma Tor Vergata, Dept Gen Surg, PhD Program Appl Med Surg Sci, Rome, Italy
Adamina, M:
Univ Basel, Kantonsspital Winterthur, Dept Surg, Basel, Switzerland
Univ Basel, Fac Med, Basel, Switzerland
Alarcon, I:
Univ Autonoma Barcelona, Gen & Digest Surg Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Arezzo, A:
Univ Torino, Dept Surg Sci, Turin, Italy
Rodriguez, JB:
Fdn IRCCS Ca Granda Osped Maggiore Policlin Milan, Dept Surg, Milan, Italy
Boni, L:
Bellvitge Univ Hosp, Barcelona, Spain
Biondo, S:
Bellvitge Univ Hosp, Barcelona, Spain
Carrano, FM:
Univ Roma Tor Vergata, Dept Gen Surg, PhD Program Appl Med Surg Sci, Rome, Italy
Chand, M:
UCL, Div Surg & Intervent Sci, London, England
Jenkins, JT:
North West London NHS Trust, Dept Colorectal Surg, St Marks Hosp, London, England
Davies, J:
Addenbrookes Hosp, Cambridge Colorectal Unit, Cambridge, England
Univ Cambridge, Cambridge, England
Rivilla, SD:
Hosp Univ MutuaTerrassa, Dept Gen Surg, Barcelona, Spain
Delrio, P:
IRCCS Fdn Pascale, Ist Nazl Tumori, Colorectal Surg Oncol, Naples, Italy
Elmore, U:
Univ Vita Salute San Raffaele, San Raffaele Hosp IRCCS, Dept Gastrointestinal Surg, Milan, Italy
Espin-Basany, E:
Univ Autonoma Barcelona, Hosp Valle Hebron, Colorectal Surg Unit, Barcelona, Spain
Fichera, A:
Baylor Univ, Med Ctr, Dept Surg, Div Colorectal Surg, Dallas, TX 75246 USA
Lorente, BF:
La Fe Univ Hosp, Digest Surg Dept, Valencia, Spain
Francis, N:
Yeovil Dist Hosp NHS Fdn Trust, Dept Gen Surg, Higher Kingston, Yeovil, England
Ruiz, MG:
Hosp Univ Marques de Valdecilla, Colorectal Surg Unit, Santander, Spain
IDIVAL, Valdecilla Biomed Res Inst, Santander, Spain
Hahnloser, D:
Univ Hosp Lausanne, Lausanne, Switzerland
Licardie, E:
Hosp Quironsalud Sagrad Corazon, Unit Gen & Digest Surg, Seville, Spain
Martinez, C:
Univ Autonoma Barcelona, Gen & Digest Surg Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Ortenzi, M:
Univ Politecn Marche, Dept Gen Surg, Ancona, Italy
Panis, Y:
Hop Beaujon, Dept Colorectal Surg, Clichy, France
Idoate, CP:
Univ Clin Navarre, Dept Gen Surg, Div Colorectal Surg, Madrid, Spain
Paganini, AM:
Sapienza Univ Rome, Dept Gen Surg & Surg Specialties Paride Stefanini, Rome, Italy
Pera, M:
Hosp del Mar Med Res Inst IMIM, Hosp del Mar, Barcelona, Spain
Perinotti, R:
Biella Hosp, Dept Gen Surg, SS Colo Rectal & Proctol Surg, Ponderano, Biella, Italy
Popowich, DA:
St Francis Hosp, Roslyn, NY USA
Rockall, T:
Royal Surrey NHS Fdn Trust, Gen Surg, Guildford, Surrey, England
Rosati, R:
Univ Vita Salute San Raffaele, San Raffaele Hosp IRCCS, Dept Gastrointestinal Surg, Milan, Italy
Sartori, A:
San Valentino Hosp, Dept Gen & Emergency Surg, Treviso, Italy
Scoglio, D:
San Dona di Piave Gen Hosp, Dept Gen Surg, AULSS Veneto Orientale 4, San Dona Di Piave, Italy
Shalaby, M:
Mansoura Univ, Mansoura Univ Hosp, Dept Gen Surg, Colorectal Surg Unit, Mansoura, Egypt
Fernandez, VS:
Rio Hortega Hosp, Coloproctol Unit, Valladolid, Spain
Smart, NJ:
Exeter Hosp, Exeter, Devon, England
Spinelli, A:
Humanitas Univ, Dept Biomed Sci, Milan, Italy
IRCCS Humanitas Res Hosp, Div Colon & Rectal Surg, Milan, Italy
Sylla, P:
Mt Sinai Hosp, New York, NY 10029 USA
Tanis, PJ:
Univ Amsterdam, Canc Ctr Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Erasmus MC, Dept Surg Oncol & Gastrointestinal Surg, Rotterdam, Netherlands
Valdes-Hernandez, J:
Virgen Macarena Univ Hosp, Colorectal Surg Unit, Gen & Digest Surg Unit, Seville, Spain
Wexner, SD:
Cleveland Clin Florida, Dept Colorectal Surg, Weston, FL USA
Sileri, P:
Univ Vita Salute San Raffaele, San Raffaele Hosp IRCCS, Dept Gastrointestinal Surg, Milan, Italy
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