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Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?

  • 2021 SAGES Oral
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Abstract

Background

Early ileostomy closure (EIC), \(\le\) 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.

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Acknowledgements

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.

Funding

There were no sources of funding associated with this project.

Author information

Author notes

  1. Fateme Rajabiyazdi and Marylise Boutros made equal contributions as senior authors.

Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, McGill University Health Centre, Montreal, QC, Canada

    Natasha G. Caminsky, Jeongyoon Moon, Alexander Sender Liberman & Marylise Boutros

  2. Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada

    Natasha G. Caminsky, Jeongyoon Moon, Nancy Morin, Carol-Ann Vasilevsky & Marylise Boutros

  3. Division of Colon and Rectal Surgery, University of Massachusetts, Boston, MA, USA

    Karim Alavi

  4. Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Rebecca C. Auer

  5. Department of Surgery, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA, USA

    Liliana G. Bordeianou

  6. Minimally Invasive and Colorectal Surgery, University Health Network and Princess Margaret Hospital, Toronto, ON, Canada

    Sami A. Chadi

  7. Department of Surgery, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec City, QC, Canada

    Sébastien Drolet

  8. Division of Colon and Rectal Surgery, St. Paul’s Hospital, Vancouver, BC, Canada

    Amandeep Ghuman

  9. Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    Tony MacLean

  10. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Ian M. Paquette

  11. Department of Surgery, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada

    Jason Park

  12. Department of Surgery, Queens University, Kingston, ON, Canada

    Sunil Patel

  13. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    Scott R. Steele

  14. Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Patricia Sylla

  15. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

  16. Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada

    Fateme Rajabiyazdi

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  1. Natasha G. Caminsky
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  2. Jeongyoon Moon
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  19. Fateme Rajabiyazdi
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Corresponding author

Correspondence to Marylise Boutros.

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Disclosures

Dr. Natasha G Caminsky received the Smith International Surgical Scholarship from the Cleveland Clinic Florida for travel support to attend the 31st Annual International Colorectal Disease Symposium (presentation related to this project). Dr. Sami A Chadi has received speaker honorarium and consultancy fees from Stryker Endoscopy. Dr. Alexander Sender Liberman is the recipient of funding from Takeda as site surgical lead for a clinical trial. Dr. Liberman has also received payment/honoraria for serving on the Medical Advisory Committee for Merck, Servier for speaking at an educational event, and Ipsen for giving a lecture. Dr. Steven D Wexner receives royalties from Inventor’s income from Medtronic, Intuitive Surgical, Karl Storz Endoscopy American, and Unique Surgical Innovations LLC. Dr. Steven Wexner also receives consulting fees from Intuitive Surgical, Stryker, Medtronic, Takeda, ARC/Corvus, Astellas, Baxter, Olympus, and Advances in Surgery Channel. Finally, Dr. Steven Wexner has stock options in Regentys, LifeBond, Pragma/GibLib, and Renew Medical. Dr. Marylise Boutros is the recipient of a teaching honorarium from Johnson and Johnson. Drs. Jeongyoon Moon, Nancy Morin, Karim Alavi, Rebecca C Auer, Liliana G Bordeianou, Sébastien Drolet, Amandeep Ghuman, Tony MacLean, Ian M Paquette, Jason Park, Sunil Patel, Scott Steele, Patricia Sylla, Carol-Ann Vasilevsky, and Fateme Rajabiyazdi have no conflicts of interest or financial ties to disclose.

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Caminsky, N.G., Moon, J., Morin, N. et al. Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?. Surg Endosc 37, 669–682 (2023). https://doi.org/10.1007/s00464-022-09580-5

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