Rate Of Stoma Formation Research Articles

Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-Analysis.

Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality. Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery. Systematic searches of Ovid MEDLINE, Ovid EMBASE, and Cochrane electronic databases were performed for studies published from 1 January 1990 to 27 August 2023. Studies were included investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against non-colorectal surgeon specialization. Exclusion criteria were: (1) publications studying primarily pediatric populations; (2) studies incorporating patients who had undergone surgery prior to 1990; (3) studies only published in abstract form or non-English language. Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach. Of 7676 studies identified, 155 were selected for full-text review and 21 studies were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64, 95% CI 0.60-0.68, p < 0.0001) and in hospital mortality (OR 0.66, 95% CI 0.49-0.89, p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95, 95% CI 2.02-4.31, p < 0.0001) and use of laparoscopic surgery (OR 2.38, 95% CI 1.42-4.00, p = 0.001) amongst specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52, 95% CI 0.28-0.98, p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70, 95% CI 0.45-1.07, p = 0.10) or reintervention rates (OR 0.78, 95% CI 0.55-1.10, p = 0.16). Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries. Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved post-operative mortality, lower rates of stoma formation and increased rates of primary anastomosis and minimally invasive surgery. CRD42022300541.

WP5.6 - Beyond the Left Side: Emergency Colonic Stenting for Acute Malignant Large Bowel Obstruction

Abstract Introduction Acute malignant large bowel obstruction (LBO) is traditionally treated by surgical diversion or resection in patients who are fit enough. European guidelines suggest colonic stenting as a bridge to surgery in curative disease. The aim was to examine the safety and efficacy of a change in practice from emergency laparotomy towards colonic stenting for acute malignant LBO. Methods Patients with LBO from 01/01/2019 to 31/12/2022 were included and data was obtained from the NELA database and electronic patient records. Results 42 patients underwent emergency laparotomy (EL) for LBO. 33% (14/42) patients had right-sided tumours (n=14) and/or perforated disease (n=6) where stenting was contraindicated. 28/42 patients (22% of total) went straight to EL for clinical/ organisation factors. 73 patients were stented; 44% (32/73) were at/ proximal to splenic flexure. Perforation rate was 10% (7/73) with 4/7 requiring EL. Failure rate was 14% (10/73) with 6/10 patients requiring EL. 41% (30/73) were stented with curative intent; 70% (21/30) then underwent elective resection. The rate of stoma formation and minimally invasive surgery in patients stented with curative intent was 40% (12/30) and 60% (18/30) respectively (including 9 EL following stent complications). Compared with 88% (37/42) and 19% (8/42) in patients undergoing primary EL. Conclusion Almost 2/3 of patients presenting with acute malignant LBO were suitable for stenting. Stenting reduced the need for a stoma and enabled elective minimally invasive surgery with low complication rates. This rate of colonic stenting was achievable without a 24/7 colonic stenting rota or sub-specialty cover.

FP3.15 - Are non-colorectal surgeons more likely to make a stoma in an emergency right hemicolectomy for cancer?

Abstract Introduction Right sided colonic cancers can often cause bowel obstruction and present as an emergency. The decision to perform an anastomois following a right hemicolectomy resection is frequently multifactorial. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in stoma formation rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy. Methods A retrospective study was conducted at a 3 site Trust in South East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Results There were 281 patients included in the study, in a 152:129 female:male ratio. The mean age was 68 (34-86 IQR). 13% (37/281) of operations were conducted by Upper Gastro-intestinal Surgeons. 54% (20/37) of these patients had stoma formation as part of their operation. 47% (115/244) of operations undertaken by colorectal surgeons also had stoma formation. There was no significant difference between the stoma formation between colorectal and non-colorectal surgeons (p=0.108) Conclusion The study shows that although the decision to form a stoma following a right hemicolectomy multifactorial and is dependent on a wealth of patient and operative factors, there is no statistical difference between colorectal and non-colorectal surgeons in the emergency setting.

Surgical outcomes in ileal Crohn's disease complicated by ileosigmoid fistula.

The management of Crohn's disease (CD) complicated by ileosigmoid fistula (ISF) remains a challenge, and Australian outcomes have not previously been reported. A retrospective review of a tertiary colorectal inflammatory bowel disease unit, across public and private sites, from 2005 to 2023 to identify adult patients having undergone operative management of ISF. Twenty-nine patients underwent surgery for ISF in the study period. Seventeen were male and the median age was 40 years. The pre-operative diagnosis of ISF was made in 76%, and patients were more likely to undergo resectional surgery if the pre-operative diagnosis was made endoscopically. Sixty-nine percent of cases were performed electively, with 76% completed laparoscopically with an 18.5% conversion rate to an open approach. The ISF was oversewn in three patients, repaired primarily in 14 patients, managed with segmental wedge resection in eight patients and resected via an anterior resection in four patients. The rate of stoma formation at the index procedure was 20.7% overall and 22% in patients being acutely managed with steroids. Emergent cases were more likely to be defunctioned with a stoma. Morbidity was 17.2% with a single anastomotic leak. ISF in CD remains difficult to diagnose pre-operatively, but can be safely managed laparoscopically without formal resection, and with limited use of diverting stoma formation. The specific surgical approach to the sigmoid in ISF is difficult to pre-determine and often requires decisions to be made intra-operatively.

Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis.

Patients with obstructive colorectal cancer managed by emergency surgery show high morbidity, mortality, and stoma formation rates. Decompression modalities, including the self-expandable metallic stent (SEMS) and tube drainage (TD), have been used to improve surgical outcomes. However, there have been limited studies comparing the 2 modalities. We performed a meta-analysis on short- and long-term outcomes between SEMS and TD. PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. Data were pooled, and the overall effect size was calculated using random effect models. Outcome measures were perioperative short-term and 3-year survival outcomes. We included 20 nonrandomized studies that examined 2,047 patients in the meta-analysis. The meta-analysis showed SEMS had better short-term outcomes in clinical success rate, decompression-related complications, laparoscopic surgery rate, stoma formation rate, and postoperative complication rate with a relative risk (RR) of 0.36 (95% confidence interval [CI], 0.24-0.54; I2 = 20%), 0.32 (95% CI, 0.20-0.50; I2 = 0%), 0.47 (95% CI, 0.34-0.66; I2 = 87%), 0.34 (95% CI, 0.24-0.49; I2 = 52%), and 0.70 (95% CI, 0.54-0.89, I2 = 28%), respectively. However, there was no significant difference between the 2 groups in 3-year overall survival (RR, 0.99; 95% CI, 0.77-1.27; I2 = 0%). Although the long-term oncologic impact of SEMS is still unclear compared with TD, the results of this meta-analysis may suggest that SEMS insertion can be performed more successfully and safely and may have benefits for short-term perioperative outcomes compared with TD. Further studies are warranted to provide more definitive survival results.

832 Analysis of Surgical Outcomes and Survival Benefit of Simultaneous Resection of the Primary Colonic Tumour and Liver Metastasis – Experience of a UK Tertiary Centre Between 2013-2022

Abstract Introduction 22% of patients with colorectal cancer present with synchronous metastases. Traditionally, surgical management for these patients is performed separately although increasingly these are being done as simultaneous resections as supported by NICE, UK. Large-scale data to support this is limited and heterogeneous. Aim We aimed to analyse the experience of simultaneous resection at a UK tertiary centre with attention to surgical, oncological outcomes, and survival benefits. Method A prospective database between 2013-2022 was analysed, and clinical data were collared. Statistics performed using R. Results Ninety-six simultaneous resections were reviewed. 71% were left-sided including rectal and 29% were right-sided, while 69% and 31% of patients underwent minor and major liver resections respectively. The majority of cases were performed as open (77%), laparoscopic (16%), or converted to open (6.5%). 30-day mortality was 1% and morbidity rate was 55.4% (Clavien Dindo III 39.2%, IV 4%). Stoma formation rate was 34%. To date, 62% had recurrent disease, 55% received further chemotherapy and 29% had further resections. Median time to recurrence was 31.2 weeks. Median total survival was 34 months. Left-sided and minor liver resections tended towards improved survival, but this was non-significant; survival was significantly improved for those patients diagnosed via the bowel cancer screening program (BSCP). Conclusions Simultaneous resection of colorectal cancer and liver metastases is safe with low mortality and an acceptable morbidity rate. Overall survival of 34 months is promising with further analysis required into oncological strategies and improving uptake of the BSCP.

SP10.7 Robotic versus laparoscopic surgery for colorectal cancer treatment – a comparison of outcomes in the quest for superiority

Abstract Background This research analysed short-term outcome results of robotic and laparoscopic surgery for colorectal cancer patients. The objective was to determine the advantages of using robotics in minimal invasive surgery and to investigate if there is a significant variation in outcomes based on the surgical method utilised. Methods The study conducted a retrospective analysis of all patients who received robotic and laparoscopic surgery for colorectal cancer treatment between 2020 and 2022. The data collected included demographics, as well as information on pre-, intra-, and post-operative periods. Results This study evaluated 120 surgeries for colorectal cancer patients, 83 were robotic and 37 were laparoscopic. The rate of stoma formation was higher in laparoscopic procedures (48.6%) compared to robotic surgeries (30.1%). Robotic surgery had a slightly longer average length of operation (279.6 minutes) compared to laparoscopic procedures (254.8 minutes), but the average length of hospital stays for patients who underwent robotic surgery was approximately 5 days shorter. Furthermore, the rate of readmission within 30 days was 12% higher for patients who underwent laparoscopic procedures compared to those who underwent robotic surgery. No patients in the robotic group required conversion to open surgery whereas one laparoscopic procedure necessitated conversion to open. Globally, the mortality rate was 0%. Conclusion This study suggests that robotic surgery can be a safe and effective option for approach to surgical colorectal cancer treatment. Robotic surgery offers shorter hospital stays compared to laparoscopic surgery with fewer complications and readmissions. Overall, these findings suggest that robotic surgery may be a superior approach to minimally invasive surgery for colorectal cancer patients.

Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients

ObjectiveWeighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication.MethodsAll patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed.Results585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001).ConclusionThe lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.

A retrospective audit of robotic versus laparoscopic anterior resection for diverticular disease in a single surgeon’s experience

Background: There has been a shift towards elective resection for recurrent or complicated diverticular disease to prevent recurrent episodes of diverticulitis. Our study aims to compare the outcomes in elective robotic and laparoscopic anterior resection for diverticular disease by a single surgeon experienced in both techniques. Methods: This is a retrospective study of patients who underwent elective anterior resections at Nepean Public Hospital, Nepean Private Hospital, and Sydney Adventist Hospital (SAN) in the last 10 years. The single surgeon is an experienced surgeon who has performed laparoscopic anterior resections from January 2013 to December 2018; and mainly robotic anterior resections from January 2018 to July 2022. The primary outcome of this study was to determine if there were any differences in length of stay and post-operative complications in laparoscopic and robotic anterior resections. Secondary outcome measures included operating time, rate of conversion to open surgery, and 30-day mortality and morbidity. Results: There were 53 patients included in this study. There was no significant difference in conversion to open rates (p=0.528), mean operative time (p=0.095), stoma formation rates (p=0.528) and post-operative complication rates (0.609). Length of stay was significantly shorter in the robotic group (p=0.024), and a higher proportion of patients who had laparoscopic surgery stayed for ≥6 days (p=0.08). There were no anastomotic leakages, or 30-day mortality and morbidity. Conclusions: Robotic anterior resection is a feasible approach in experienced hands and produces comparable results to laparoscopic anterior resection for diverticular disease in terms of length of stay, post-operative complications, and operative timings.

Stapled disc excision for the repair of intraoperative rectal injury during robotic surgery for deep infiltrating endometriosis

Intraoperative rectal perforation is an uncommon complication of pelvic surgery, which can be life-threatening and often leads to high morbidity and stoma formation rate. No consensus has been reached regarding a standard of care for intraoperative iatrogenic pelvic injury. This article presents a technique for a stapled repair to completely resect a full-thickness low rectal perforation during robotic surgery for advanced endometriosis and avoid a high-risk colorectal anastomosis and the possible need for stoma formation. Stapled discoid excision is a novel and safe technique for the repair of intraoperative rectal injuries, showing multiple benefits compared to the standard colorectal resection with or without anastomosis.

Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes.

The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection. The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes. Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable. Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.

Delaying surgery for optimization after colonic stent bridging is safe for left-sided malignant large bowel obstruction: Result from 10-year experience and risks factor analysis

AimTo evaluate the operative and oncological results after colonic stent bridging for left-sided malignant large bowel intestinal obstruction and the risk factors for survival and recurrence after definitive surgery. MethodologyConsecutive patients who underwent colonic stenting for malignant left-sided colonic obstruction were included. Patients for palliative stenting or emergency surgery, patient with low rectal tumour or peritoneal metastasis were excluded. The primary outcome was overall survival. Secondary outcomes included stent success rate, stenting related complications, rate of stoma formation and long-term oncological outcome including recurrence rate and recurrence free survival rate. ResultsFrom June 2011 to June 2021, a total of 222 patients underwent colonic stenting. 112 patients were bridged to surgery after initial stenting, but 7 patients dropped out. Overall survival was 35 months (IQR = 17.75–75.25 months) in the early operation group, 30 months (IQR = 17.5–49.5 months) in the delayed surgery group HR 0.981 (95%CI 0.70–1.395, p = 0.907). Sensitivity analysis performed by excluding stent complications and emergency surgery yielded the same conclusion. Overall stenting complications rate was 17.1%. 11 patients (10.4%) required emergency surgery. ConclusionThere was no difference between early and delayed surgery groups (>4weeks) in the overall survival and recurrence in patients who had stent-bridge to surgery for malignant left colonic obstruction. It is safe to defer definitive surgery to optimize patients and allow better recovery from initial obstruction after colonic stenting before definitive surgery without adversely affecting the oncological outcomes.

Treatment of obstructive colorectal cancer

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.

Self-expandable metallic stents as a bridge to surgery in obstructive right- and left-sided colorectal cancer: a multicenter cohort study

The insertion of a self-expandable metal stent (SEMS) has been proposed as an alternative to emergent surgery (ES) for obstructive colorectal cancer (CRC). We aimed to evaluate the perioperative and oncologic outcomes of SEMS as a bridge to surgery in obstructive CRC, as compared with ES. We retrospectively reviewed the medical records of patients who underwent curative resection of obstructive CRC at four Hallym University-affiliated hospitals between January 2010 and December 2019. All patients were analyzed overall colon, then according to the side of obstruction (overall, right or left). Of 167 patients, 52 patients underwent ES and 115 underwent SEMS insertion and surgery (SEMS group). The postoperative hospital stay and time to soft diet were shorter in the SEMS group than in the ES group for overall and both sided cancer. The SEMS group had lower rates of stoma formation and severe complications for overall and for left-sided cancer. The 5-year overall survival (P = 0.682) and disease-free survival (P = 0.233) rates were similar in both groups. SEMS insertion as a bridge to surgery was associated with faster recovery, a lower rate of stoma formation with similar oncologic outcomes to those of ES.

Body Image Issues in Patients With Colorectal Cancer: A Scoping Review.

Stomas in colorectal cancer (CRC) survivors lead to body image problems. Advances in treatment help reduce the rate of stoma formation, but body image distress is still frequently experienced in CRC survivors. This review is aimed toward mapping and describing the state of knowledge regarding body image in patients with CRC. A systematic literature search complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Screening and data extraction were performed by 2 reviewers independently for all potentially eligible studies. A total of 56 eligible articles were selected. The majority of these studies were quantitative studies (85%). The eligible studies were classified into 4 broad categories: instruments used to assess body image, prevalence of body image distress, factors related to body image, and impact of body image distress. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-CR38) colorectal questionnaire was the most common measurement tool found among the reviewed studies (70%), and body image distress was reported by 25.5% to 86% of participants. Excluding gender, age, type of surgery, adjuvant therapy, time from diagnosis, social support, and stoma status, changes in bowel habits was identified as affecting the body image of patients with CRC. Changing bowel habits emerged as a significant factor causing body image distress for CRC survivors. Clinicians should raise awareness about body image distress in patients with CRC, focus on finding effective measures and interventions intended to help alleviate symptoms of bowel dysfunction, and prepare patients to adapt to altered bowel functions.

TU3.1 Effect of COVID-19 on stoma formation rates in elective left sided colorectal cancer resections

AimsThe primary aim of the study was to assess the effect of COVID-19 on rate of stoma formation in elective left sided colorectal cancer resections. Other possible effects of COVID-19 on the management of these patients were explored too.MethodsRetrospective review of elective left sided colorectal cancer resections over a 2 years period. Patients were divided into 2 groups, Pre-COVID (4/2019–3/2020) and Post-COVID (4/2020–3/2021) There were 43 resections in the Pre-COVID group and 21 resections in the post-COVID groupResultsPatient demographics were comparable in both groups. There was a 30% reduction in total number of colorectal cancer resections and 50% reduction in left sided resections. There was a 3 fold increase in patients not anastomosed primarily post-COVID (from 20.5% to 61%). There was a 2 fold increase in patients ending up with a stoma including patients undergoing primary anastomosis but with defunctioning stomas(from 38.4% to 72.2%). Procedures completed laparoscopically were more or less comparable in both groups. Conversion rate was slightly higher in the post-COVID group (from 14.3% to 21%).ConclusionSignificant increase in stoma formation in the post COVID group most likely due to guidelines from the royal college early in the pandemic but other possibilities include delay in treatment. More studies are required as the pandemic continues to explore this further and determine whether this was justified and to enable us to adapt to the new normal and assess whether we can return safely to our pre-COVID practice without compromising patient outcomes or adding to their morbidity.

TH3.8 Retrospective study on the use of colonic stents in malignancy; a bridge to surgery or the end of the line?

Abstract Aim Colonic stenting is a management option for obstructed left sided colorectal malignancy in the emergency and elective setting. Stenting can provide a bridge to curative surgery or to adjuvant treatment. The aim of this study was to assess the role of colonic stenting in management of obstructed colorectal cancer. Methods This retrospective cohort study analyses prospectively collected data from two centres within one Health Board in Wales. Patients were recorded in a cancer database, who underwent colonic stenting for left sided colonic malignancy between January 2008 and December 2021. Patient demographics, treatment pathways, length of admission, stoma formation rates and morbidity were recorded. Results In total, 98 patients, with a mean age of 73.5 years (range 37–97) underwent a colonic stent. The majority were elective 55% (n=54). The sigmoid colon was the commonest site of tumour in 33 patients, with metastatic disease in 82% (n=80). The study found 86% (n=84) of patients were successfully stented. The mean length of admission was 13 days. The complication rate was 23% (n=23), most commonly stent obstruction (n=6). Stenting was a bridge to curative surgery for 3 patients, and 47% (n=46) received adjuvant treatment. Five-year survival was 19.3% (n=19). The overall stoma rate was 10.2% (10 patients). Conclusion This study shows colonic stenting is a viable alternative in surgical management for advanced obstructing colorectal malignancy but not as a bridge to surgery. The majority of this cohort returned home following stenting, had a low overall stoma rate and 19% survival at 5 years.

Differences in clinical outcomes according to the time interval between the bridge to surgery stenting and surgery for left-sided malignant colorectal obstruction

BackgroundSelf-expandable metal stent (SEMS) placement is commonly used as a bridge to surgery (BTS) for left-sided malignant colorectal obstruction (MCO). However, the optimal time interval between BTS stenting and surgery for left-sided MCO is unclear, and the results of previous studies are conflicting. This study aimed to determine the differences in clinical outcomes according to the time interval between BTS stenting and surgery in left-sided MCO.MethodsData from 594 patients who underwent SEMS placement for MCO between January 2009 and December 2018 were reviewed. Among them, 148 patients who underwent SEMS placement as BTS treatment and curative surgery were enrolled. The enrolled patients were divided into three groups according to the interval between BTS stenting and surgery: group 1 (interval ≤2 weeks), group 2 (interval 2–3 weeks), and group 3 (interval >3 weeks).ResultsGroup 2 and 3 patients underwent significantly higher rates of laparoscopic surgery than those in group 1 (83.7, 81.0 vs. 53.2 %, respectively; P=0.003, P=0.003, respectively). Also, rates of stoma formation directly after resection were significantly higher in group 1 compared to groups 2 and 3 (21.3 vs 2.3, 6.9%, respectively; P=0.008, P=0.043, respectively). Bridging interval had no effect on SEMS-related complications, resection-related complications, 90-day mortality, permanent stoma formation, 3-year disease-free survival, and 3-year overall survival.ConclusionsA bridging interval of > 2 weeks between BTS stenting and surgery for left-sided MCO is preferable for lower stoma formation rates and higher rates of laparoscopic approach operation, with no difference in short-term and long-term outcomes including complication, mortality, and survival.

OP12 Segmental vs Total Colectomy for Crohn’s Disease of the colon in the biologic era. Results from the SCOTCH international, multicentric study

Abstract Background Previous studies suggested a role for segmental colectomy (SC) and total colectomy (TC) for colonic Crohn’s disease (cCD). TC might reduce recurrence rates, at the cost of impaired quality of life and higher stoma rates. We compared the long-term outcomes of SC and TC. Methods This is an international, multicentric study on data from the prospective databases of six centres. All consecutive patients operated on between 2000 and 2019 for cCD with SC or TC were included. Exclusion criteria were colorectal cancer, previous bowel resections, and lack of follow-up data. Disease extension was based on involvement of 1 to 5 colonic segments. Resection of 1–3 segments was classified as SC, resection of 4–5 segments as TC. Primary aim was surgical recurrence after SC vs TC. Secondary aims were perioperative complications, stoma formation rate, and predictors of recurrence. Results Data of 687 (56.2% women) patients were analysed. Mean age at diagnosis and at surgery were 30±15.8 and 40.4±15.4 years. Disease duration was 10.4 ± 8.6 years. 16.6% of patients were A1, whereas most (62.2%) were diagnosed between 17 and 40 years. Isolated cCD (L2) was present in 61.1%, ileocolic CD (L3) in 38.9%, and concomitant jejuno-ileal CD (L4) in 3.2%. Most had stricturing (B2) cCD (41.9%). Active perianal disease was found in 28.9% patients. SC was performed in 285 patients, TC in 402. The latter more frequently had isolated cCD, inflammatory (B1) disease, current (37.8 vs 16.5%, p&amp;lt;0.001) or previous (56 vs 32.6%, p&amp;lt;0.001) perianal CD, and longer disease duration (11.3 ± 8.9 vs 9.2 ± 7.9, p&amp;lt;0.001). Postoperative complications and mortality were similar, but TC patients more frequently required 90-day readmission (6% vs 2.1%, p=0.02). Temporary (31.6 vs 21.4%, p&amp;lt;0.001) and definitive (39.3vs8%, p&amp;lt;0.001) stomas were more likely after TC. The 15-year cumulative surgical recurrence was 36%, more likely in the TC group (44 vs 27%, Log-Rank p=0.006), and it was not affected by the number of colonic segments involved (23 vs 28%, 1–3 vs 4–5 segments p=0.2) (Fig 1). In patients with 1–3 segments involved, postoperative treatment with biologics, compared to any other regimen, reduced the risk of recurrence (25 vs 51%, p&amp;lt;0.001), while early age at diagnosis (p=0.02) and perianal CD (p=0.01) increased the risk. Omission of biological therapy (HR 5.4, 95%CI 5.1–5.8 p&amp;lt;0.001), and paediatric diagnosis (HR 2.1, 95%CI 2.3–3.1 p&amp;lt;0.001) were the strongest predictors of recurrence in this subgroup. Conclusion In this study, SC was safe, required less frequently stoma and repeated surgery, compared with TC. These findings question previous data on the topic and might be supported by the efficacy of postoperative biologic therapy on cCD.

Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series.

BackgroundSevere intra-abdominal sepsis (IAS) is associated with high mortality and stoma rates. A two-stage approach with initial damage-control surgery (DCS) and subsequent reconstruction might decrease stoma and mortality rates but requires standardization.MethodsA standardized two-stage damage-control algorithm for IAS was implemented in April 2016 and applied systematically.ResultsSome 203 consecutive patients (median age 70 years, 62 per cent ASA score greater than 3) had DCS for severe IAS. Median operation time was 82 minutes, 60 per cent performed during night-time. Median intraoperative noradrenaline doses were 20 (i.q.r. 26) µg/min and blood gas analysis (ABG) was abnormal (metabolic acidosis) in 90 per cent of patients. The second-stage operation allowed definitive surgery in 76 per cent of patients, 24 per cent had up to four re-DCSs until definitive surgery. The in-hospital mortality rate was 26 per cent. At hospital discharge, 65 per cent of patients were stoma free. Risk factors for in-hospital death were noradrenaline (odds ratio 4.25 (95 per cent c.i. 1.72 to 12.83)), abnormal ABG (pH: odds ratio 2.72 (1.24 to 6.65); lactate: odds ratio 6.77 (3.20 to 15.78)), male gender (odds ratio 2.40 (1.24 to 4.85)), ASA score greater than 3 (odds ratio 5.75 (2.58 to 14.68)), mesenteric ischaemia (odds ratio 3.27 (1.71 to 6.46)) and type of resection (odds ratio 2.95 (1.24 to 8.21)). Risk factors for stoma at discharge were ASA score greater than 3 (odds ratio 2.76 (95 per cent c.i. 1.38 to 5.73)), type of resection (odds ratio 30.91 (6.29 to 559.3)) and longer operation time (odds ratio 2.441 (1.22 to 5.06)).ConclusionInitial DCS followed by secondary reconstruction of bowel continuity for IAS within 48 hours in a tertiary teaching hospital was feasible and safe, following a clear algorithm.