Aim: The 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. Method: Fifty 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. Results: Overall, 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%). Conclusion: The 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.

Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective? / Balla, Andrea; Saraceno, Federica; Rullo, Marika; Morales-Conde, Salvador; Targarona Soler, Eduardo M.; Di Saverio, Salomone; Guerrieri, Mario; Lepiane, Pasquale; DI LORENZO, Nicola; Adamina, Michel; Alarcón, Isaias; Arezzo, Alberto; Bollo Rodriguez, Jesus; Boni, Luigi; Biondo, Sebastiano; Maria Carrano, Francesco; Chand, Manish; Jenkins, John T.; Davies, Justin; Delgado Rivilla, Salvadora; Delrio, Paolo; Elmore, Ugo; Espin-Basany, Eloy; Fichera, Alessandro; Flor Lorente, Blas; Francis, Nader; Gómez Ruiz, Marcos; Hahnloser, Dieter; Licardie, Eugenio; Carmen, Martinez; Ortenzi, Monica; Panis, Yves; Pastor Idoate, Carlos; Paganini, Alessandro M.; Pera, Miguel; Perinotti, Roberto; Popowich, Daniel A.; Rockall, Timothy; Rosati, Riccardo; Sartori, Alberto; Scoglio36, Daniele; Shalaby, Mostafa; Simó Fernández, Vicente; Smart, Neil J.; Spinelli, Antonino; Sylla, Patricia; Tanis, Pieter J.; Valdes-Hernandez, Javier; Wexner, Steven D.; Sileri, Pierpaolo. - In: COLORECTAL DISEASE. - ISSN 1463-1318. - 25:4(2023), pp. 647-659. [10.1111/codi.16454]

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

Andrea Balla
Primo
Conceptualization
;
Marika Rullo;Nicola Di Lorenzo;Francesco Maria Carrano;Carmen Martinez;Alessandro M. Paganini
Conceptualization
;
2023

Abstract

Aim: The 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. Method: Fifty 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. Results: Overall, 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%). Conclusion: The 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.
2023
adenocarcinoma; anterior resection of the rectum; decision-making process; defunctioning stoma; protective ileostomy
01 Pubblicazione su rivista::01a Articolo in rivista
Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective? / Balla, Andrea; Saraceno, Federica; Rullo, Marika; Morales-Conde, Salvador; Targarona Soler, Eduardo M.; Di Saverio, Salomone; Guerrieri, Mario; Lepiane, Pasquale; DI LORENZO, Nicola; Adamina, Michel; Alarcón, Isaias; Arezzo, Alberto; Bollo Rodriguez, Jesus; Boni, Luigi; Biondo, Sebastiano; Maria Carrano, Francesco; Chand, Manish; Jenkins, John T.; Davies, Justin; Delgado Rivilla, Salvadora; Delrio, Paolo; Elmore, Ugo; Espin-Basany, Eloy; Fichera, Alessandro; Flor Lorente, Blas; Francis, Nader; Gómez Ruiz, Marcos; Hahnloser, Dieter; Licardie, Eugenio; Carmen, Martinez; Ortenzi, Monica; Panis, Yves; Pastor Idoate, Carlos; Paganini, Alessandro M.; Pera, Miguel; Perinotti, Roberto; Popowich, Daniel A.; Rockall, Timothy; Rosati, Riccardo; Sartori, Alberto; Scoglio36, Daniele; Shalaby, Mostafa; Simó Fernández, Vicente; Smart, Neil J.; Spinelli, Antonino; Sylla, Patricia; Tanis, Pieter J.; Valdes-Hernandez, Javier; Wexner, Steven D.; Sileri, Pierpaolo. - In: COLORECTAL DISEASE. - ISSN 1463-1318. - 25:4(2023), pp. 647-659. [10.1111/codi.16454]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1674100
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