Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence
BACKGROUND:Total mesorectal excision and preoperative radiotherapy in mid and low rectal cancer allow us to achieve very good oncological results. However, major and refractory low anterior resection syndrome and fecal incontinence alter the quality of life of patients with a long expected life span...
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| Veröffentlicht in: | Diseases of the colon & rectum 2018-06, Vol.61 (6), p.667-672 |
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| creator | Didailler, Romain Denost, Quentin Loughlin, Paula Chabrun, Edouard Ricard, Julie Picard, Flor Zerbib, Frank Rullier, Eric |
| description | BACKGROUND:Total mesorectal excision and preoperative radiotherapy in mid and low rectal cancer allow us to achieve very good oncological results. However, major and refractory low anterior resection syndrome and fecal incontinence alter the quality of life of patients with a long expected life span.
OBJECTIVE:We assessed the functional results of patients treated by antegrade enema for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision.
DESIGN:This is a prospective monocentric study from 2012 to 2016.
PATIENTS:Patients who underwent percutaneous endoscopic cecostomy for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision were prospectively analyzed.
MAIN OUTCOME MEASURES:We assessed the morbidity of the procedure and compared low anterior resection syndrome score, Wexner score, and Gastrointestinal Quality of Life Index before and after the use of antegrade enema.
RESULTS:Of 25 patients treated by antegrade enema over the study period, 6 (24%) had a low anterior resection, 18 (72%) had a coloanal anastomosis, and 1 (4%) had a perineal colostomy. Postoperatively, the rate of local abscess was 8%, all treated by antibiotics. Low anterior resection syndrome score (33 vs 4, p < 0.001), Wexner score (16 vs 4, p |
| doi_str_mv | 10.1097/DCR.0000000000001089 |
| format | Article |
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OBJECTIVE:We assessed the functional results of patients treated by antegrade enema for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision.
DESIGN:This is a prospective monocentric study from 2012 to 2016.
PATIENTS:Patients who underwent percutaneous endoscopic cecostomy for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision were prospectively analyzed.
MAIN OUTCOME MEASURES:We assessed the morbidity of the procedure and compared low anterior resection syndrome score, Wexner score, and Gastrointestinal Quality of Life Index before and after the use of antegrade enema.
RESULTS:Of 25 patients treated by antegrade enema over the study period, 6 (24%) had a low anterior resection, 18 (72%) had a coloanal anastomosis, and 1 (4%) had a perineal colostomy. Postoperatively, the rate of local abscess was 8%, all treated by antibiotics. Low anterior resection syndrome score (33 vs 4, p < 0.001), Wexner score (16 vs 4, p <0.001), and Gastrointestinal Quality of Life Index (73 vs 104, p < 0.001) were all significantly improved after antegrade enema. The 2 main symptoms reported by patients were sweating (28%) and local pain (36%). At the end of the follow-up, 16% (n = 4) catheters were removed, and the rate of definitive colostomy was 12% (n = 3).
LIMITATIONS:The main limitations of this study are the monocentric features and the sample size.
CONCLUSION:Antegrade enema for major and refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision appears to be a promising treatment to avoid definitive colostomy. See Video Abstract at http://links.lww.com/DCR/A608.</description><identifier>ISSN: 0012-3706</identifier><identifier>EISSN: 1530-0358</identifier><identifier>DOI: 10.1097/DCR.0000000000001089</identifier><identifier>PMID: 29722725</identifier><language>eng</language><publisher>United States: The American Society of Colon and Rectal Surgeons</publisher><subject>Adult ; Aged ; Colostomy - psychology ; Digestive System Surgical Procedures - methods ; Enema - methods ; Fecal Incontinence - prevention & control ; Fecal Incontinence - psychology ; Fecal Incontinence - therapy ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Patient Outcome Assessment ; Postoperative Complications - psychology ; Prospective Studies ; Quality of Life ; Rectal Neoplasms - psychology ; Rectal Neoplasms - radiotherapy ; Rectal Neoplasms - surgery</subject><ispartof>Diseases of the colon & rectum, 2018-06, Vol.61 (6), p.667-672</ispartof><rights>2018 The American Society of Colon and Rectal Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3319-380b31abcf9d7612eabdc5b7a23e39d2d8e0736153e5382d7222bca450fbb43e3</citedby><cites>FETCH-LOGICAL-c3319-380b31abcf9d7612eabdc5b7a23e39d2d8e0736153e5382d7222bca450fbb43e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29722725$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Didailler, Romain</creatorcontrib><creatorcontrib>Denost, Quentin</creatorcontrib><creatorcontrib>Loughlin, Paula</creatorcontrib><creatorcontrib>Chabrun, Edouard</creatorcontrib><creatorcontrib>Ricard, Julie</creatorcontrib><creatorcontrib>Picard, Flor</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Rullier, Eric</creatorcontrib><title>Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>BACKGROUND:Total mesorectal excision and preoperative radiotherapy in mid and low rectal cancer allow us to achieve very good oncological results. However, major and refractory low anterior resection syndrome and fecal incontinence alter the quality of life of patients with a long expected life span.
OBJECTIVE:We assessed the functional results of patients treated by antegrade enema for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision.
DESIGN:This is a prospective monocentric study from 2012 to 2016.
PATIENTS:Patients who underwent percutaneous endoscopic cecostomy for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision were prospectively analyzed.
MAIN OUTCOME MEASURES:We assessed the morbidity of the procedure and compared low anterior resection syndrome score, Wexner score, and Gastrointestinal Quality of Life Index before and after the use of antegrade enema.
RESULTS:Of 25 patients treated by antegrade enema over the study period, 6 (24%) had a low anterior resection, 18 (72%) had a coloanal anastomosis, and 1 (4%) had a perineal colostomy. Postoperatively, the rate of local abscess was 8%, all treated by antibiotics. Low anterior resection syndrome score (33 vs 4, p < 0.001), Wexner score (16 vs 4, p <0.001), and Gastrointestinal Quality of Life Index (73 vs 104, p < 0.001) were all significantly improved after antegrade enema. The 2 main symptoms reported by patients were sweating (28%) and local pain (36%). At the end of the follow-up, 16% (n = 4) catheters were removed, and the rate of definitive colostomy was 12% (n = 3).
LIMITATIONS:The main limitations of this study are the monocentric features and the sample size.
CONCLUSION:Antegrade enema for major and refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision appears to be a promising treatment to avoid definitive colostomy. See Video Abstract at http://links.lww.com/DCR/A608.</description><subject>Adult</subject><subject>Aged</subject><subject>Colostomy - psychology</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Enema - methods</subject><subject>Fecal Incontinence - prevention & control</subject><subject>Fecal Incontinence - psychology</subject><subject>Fecal Incontinence - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Patient Outcome Assessment</subject><subject>Postoperative Complications - psychology</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Rectal Neoplasms - psychology</subject><subject>Rectal Neoplasms - radiotherapy</subject><subject>Rectal Neoplasms - surgery</subject><issn>0012-3706</issn><issn>1530-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV9P2zAUxa1paHRs32BCftxLwH-SxtlbFcpAKkKC7jly7JvVW2Iz26XrF9vnw6EFoT2AX2If_e450T0IfaHkhJKqPD2rb07Ii0OJqN6hCS04yQgvxHs0SSLLeEmmh-hjCL9GhpHyAzpkVclYyYoJ-jezEX56qQHPLQwSz7oIHi9dlD2-guA8qPE6_6tMMM7iznl8s9NqaRX4b3i5AryQIeJ6NSo4Ojy7d0bjM-iMNdHcA65d70J0w3Zv0HmpovNbvHAbPP6DN496SNZjzO3Wau8GwNJqfA4qxV1a5Ww0FlLGJ3TQyT7A5_33CP04ny_ri2xx_f2yni0yxTmtMi5Iy6lsVVfpckoZyFaroi0l48ArzbQAUvJp2hkUXDCdtsJaJfOCdG2bJ-YIfd353nn3Zw0hNoMJCvpeWnDr0DDCcyaqivCE5jtUeReCh66582aQfttQ0oyNNamx5v_G0tjxPmHdDqCfh54qSoDYARvXpzWF3_16A75Zgezj6i3v_JXREeN5wTNGqCDT9MpGSfAH3MS0NA</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Didailler, Romain</creator><creator>Denost, Quentin</creator><creator>Loughlin, Paula</creator><creator>Chabrun, Edouard</creator><creator>Ricard, Julie</creator><creator>Picard, Flor</creator><creator>Zerbib, Frank</creator><creator>Rullier, Eric</creator><general>The American Society of Colon and Rectal Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201806</creationdate><title>Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence</title><author>Didailler, Romain ; Denost, Quentin ; Loughlin, Paula ; Chabrun, Edouard ; Ricard, Julie ; Picard, Flor ; Zerbib, Frank ; Rullier, Eric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3319-380b31abcf9d7612eabdc5b7a23e39d2d8e0736153e5382d7222bca450fbb43e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Colostomy - psychology</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Enema - methods</topic><topic>Fecal Incontinence - prevention & control</topic><topic>Fecal Incontinence - psychology</topic><topic>Fecal Incontinence - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Patient Outcome Assessment</topic><topic>Postoperative Complications - psychology</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Rectal Neoplasms - psychology</topic><topic>Rectal Neoplasms - radiotherapy</topic><topic>Rectal Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Didailler, Romain</creatorcontrib><creatorcontrib>Denost, Quentin</creatorcontrib><creatorcontrib>Loughlin, Paula</creatorcontrib><creatorcontrib>Chabrun, Edouard</creatorcontrib><creatorcontrib>Ricard, Julie</creatorcontrib><creatorcontrib>Picard, Flor</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Rullier, Eric</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Didailler, Romain</au><au>Denost, Quentin</au><au>Loughlin, Paula</au><au>Chabrun, Edouard</au><au>Ricard, Julie</au><au>Picard, Flor</au><au>Zerbib, Frank</au><au>Rullier, Eric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>2018-06</date><risdate>2018</risdate><volume>61</volume><issue>6</issue><spage>667</spage><epage>672</epage><pages>667-672</pages><issn>0012-3706</issn><eissn>1530-0358</eissn><abstract>BACKGROUND:Total mesorectal excision and preoperative radiotherapy in mid and low rectal cancer allow us to achieve very good oncological results. However, major and refractory low anterior resection syndrome and fecal incontinence alter the quality of life of patients with a long expected life span.
OBJECTIVE:We assessed the functional results of patients treated by antegrade enema for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision.
DESIGN:This is a prospective monocentric study from 2012 to 2016.
PATIENTS:Patients who underwent percutaneous endoscopic cecostomy for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision were prospectively analyzed.
MAIN OUTCOME MEASURES:We assessed the morbidity of the procedure and compared low anterior resection syndrome score, Wexner score, and Gastrointestinal Quality of Life Index before and after the use of antegrade enema.
RESULTS:Of 25 patients treated by antegrade enema over the study period, 6 (24%) had a low anterior resection, 18 (72%) had a coloanal anastomosis, and 1 (4%) had a perineal colostomy. Postoperatively, the rate of local abscess was 8%, all treated by antibiotics. Low anterior resection syndrome score (33 vs 4, p < 0.001), Wexner score (16 vs 4, p <0.001), and Gastrointestinal Quality of Life Index (73 vs 104, p < 0.001) were all significantly improved after antegrade enema. The 2 main symptoms reported by patients were sweating (28%) and local pain (36%). At the end of the follow-up, 16% (n = 4) catheters were removed, and the rate of definitive colostomy was 12% (n = 3).
LIMITATIONS:The main limitations of this study are the monocentric features and the sample size.
CONCLUSION:Antegrade enema for major and refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision appears to be a promising treatment to avoid definitive colostomy. See Video Abstract at http://links.lww.com/DCR/A608.</abstract><cop>United States</cop><pub>The American Society of Colon and Rectal Surgeons</pub><pmid>29722725</pmid><doi>10.1097/DCR.0000000000001089</doi><tpages>6</tpages></addata></record> |
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| ispartof | Diseases of the colon & rectum, 2018-06, Vol.61 (6), p.667-672 |
| issn | 0012-3706 1530-0358 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Aged Colostomy - psychology Digestive System Surgical Procedures - methods Enema - methods Fecal Incontinence - prevention & control Fecal Incontinence - psychology Fecal Incontinence - therapy Female Humans Male Middle Aged Morbidity Patient Outcome Assessment Postoperative Complications - psychology Prospective Studies Quality of Life Rectal Neoplasms - psychology Rectal Neoplasms - radiotherapy Rectal Neoplasms - surgery |
| title | Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence |
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