Virtual Ileostomy Versus Diverting Ileostomy

Rectal Cancer Clinical Trial

Official title:

Comparing the Safety and Efficacy of Virtual Ileostomy Versus Diverting Ileostomy in Patients Undergoing Sphincter-saving Surgery for Rectal Cancer: a Propensity-matched Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05985239
• Other study ID #: VI vs. DI
• Status: Recruiting
• Start date: January 1, 2023
• Est. completion date: April 30, 2024

Study information

• Verified date: February 2024
• Source: Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
• Contact: fan li
• Phone: +86 023 68757958
• Email: levinecq[@]163.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This study aimed at comparing the Comprehensive Complication Index (CCI), readmission rates, postoperative hospitalization days, duration of bearing the stoma (months), hospitalization costs, the number of hospitalizations with ghost ileostomy versus conventional loop ileostomy after low anterior resection for rectal cancer.

Description:

Diverting ileostomy (DI) is a common procedure performed in patients undergoing low anterior resection for rectal cancer to protect the anastomosis and reduce the risk of complications. Although DI remains one of the most common methods used in clinical practice to prevent anastomotic leakage, there is still considerable debate in clinical practice about whether to perform a routine ileostomy. Despite temporary ileostomy fecal diversion can reduce the development of abdominal abscesses, wound inflammation, peritonitis, and sepsis after the occurrence of AL, however, it not only failed to reduce the incidence of AL but significantly increased the risk of non-elective readmissions and reinterventions as well as higher total costs. Meanwhile, stoma significantly increase the risk of stoma-related complication such as small bowel obstruction, postoperative ileus, dehydration from high-output stoma culminating in acute kidney injury, electrolyte imbalance, stoma stenosis/ necrosis, parastomal hernia, peristomal abscess, and fistula, etc.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 570
• Est. completion date: April 30, 2024
• Est. primary completion date: March 30, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Pathologically confirmed low to intermediate level rectal cancer, with the lower margin of anastomosis <10cm from the anus.

• age =18 years and =80 years.

• the surgical procedure is anterior rectal resection (LAR).

• intraoperative virtual or conventional ileostomy was performed.

Exclusion Criteria:

• ASA score >3.

• Patients with coexisting complete intestinal obstruction.

• History of long-term use of immunosuppressive drugs or glucocorticoids.

• Combined severe cardiac disease: with congestive heart failure or NYHA cardiac function = grade 2. Patients with a history of myocardial infarction or coronary artery surgery within 6 months prior to the procedure.

• chronic renal failure (requiring dialysis or glomerular filtration rate <30 mL/min).

• Intraoperative combined multi-organ resection.

• Combined cirrhosis of the liver.

• Intraoperative findings of incomplete anastomosis and positive insufflation test.

Related Conditions & MeSH terms

• Rectal Cancer
• Rectal Neoplasms

Intervention

Procedure:
• VI
Laparoscopic or robotic surgery with virtual ileostomy
• DI
Laparoscopic or robotic surgery with virtual ileostomy

Locations

Country	Name	City	State
China	Daping Hospital, Third Military Medical University	Chongqing

Sponsors (1)

Lead Sponsor	Collaborator
fan li

Country where clinical trial is conducted

China, 

References & Publications (11)

Baloyiannis I, Perivoliotis K, Diamantis A, Tzovaras G. Virtual ileostomy in elective colorectal surgery: a systematic review of the literature. Tech Coloproctol. 2020 Jan;24(1):23-31. doi: 10.1007/s10151-019-02127-2. Epub 2019 Dec 9. — View Citation

Chapman WC Jr, Subramanian M, Jayarajan S, Makhdoom B, Mutch MG, Hunt S, Silviera ML, Glasgow SC, Olsen MA, Wise PE. First, Do No Harm: Rethinking Routine Diversion in Sphincter-Preserving Rectal Cancer Resection. J Am Coll Surg. 2019 Apr;228(4):547-556.e8. doi: 10.1016/j.jamcollsurg.2018.12.012. Epub 2019 Jan 9. — View Citation

Degiuli M, Elmore U, De Luca R, De Nardi P, Tomatis M, Biondi A, Persiani R, Solaini L, Rizzo G, Soriero D, Cianflocca D, Milone M, Turri G, Rega D, Delrio P, Pedrazzani C, De Palma GD, Borghi F, Scabini S, Coco C, Cavaliere D, Simone M, Rosati R, Reddavid R; collaborators from the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group. Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group. Colorectal Dis. 2022 Mar;24(3):264-276. doi: 10.1111/codi.15997. Epub 2021 Dec 6. — View Citation

Huttner FJ, Probst P, Mihaljevic A, Contin P, Dorr-Harim C, Ulrich A, Schneider M, Buchler MW, Diener MK, Knebel P. Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial. BMJ Open. 2020 Oct 15;10(10):e038930. doi: 10.1136/bmjopen-2020-038930. — View Citation

Kim JH, Kim S, Jung SH. Fecal diverting device for the substitution of defunctioning stoma: preliminary clinical study. Surg Endosc. 2019 Jan;33(1):333-340. doi: 10.1007/s00464-018-6389-4. Epub 2018 Aug 14. — View Citation

Miccini M, Amore Bonapasta S, Gregori M, Barillari P, Tocchi A. Ghost ileostomy: real and potential advantages. Am J Surg. 2010 Oct;200(4):e55-7. doi: 10.1016/j.amjsurg.2009.12.017. — View Citation

Murken DR, Bleier JIS. Ostomy-Related Complications. Clin Colon Rectal Surg. 2019 May;32(3):176-182. doi: 10.1055/s-0038-1676995. Epub 2019 Apr 2. — View Citation

Sacchi M, Legge PD, Picozzi P, Papa F, Giovanni CL, Greco L. Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer. Hepatogastroenterology. 2007 Sep;54(78):1676-8. — View Citation

Tsujinaka S, Suzuki H, Miura T, Sato Y, Shibata C. Obstructive and secretory complications of diverting ileostomy. World J Gastroenterol. 2022 Dec 21;28(47):6732-6742. doi: 10.3748/wjg.v28.i47.6732. — View Citation

Zenger S, Gurbuz B, Can U, Balik E, Yalti T, Bugra D. Comparative study between ghost ileostomy and defunctioning ileostomy in terms of morbidity and cost-effectiveness in low anterior resection for rectal cancer. Langenbecks Arch Surg. 2021 Mar;406(2):339-347. doi: 10.1007/s00423-021-02089-w. Epub 2021 Feb 4. — View Citation

Zhao S, Zhang L, Gao F, Wu M, Zheng J, Bai L, Li F, Liu B, Pan Z, Liu J, Du K, Zhou X, Li C, Zhang A, Pu Z, Li Y, Feng B, Tong W. Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer: A Randomized Clinical Trial. JAMA Surg. 2021 Dec 1;156(12):1151-1158. doi: 10.1001/jamasurg.2021.4568. — View Citation

* Note: There are 11 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Whether patients undergo terminal ostomy after low anterior resection for rectal cancer.	Hartmann's procedure or for example, abdominoperineal extirpation	Through study completion, an average of 1 year
Other	Patients with stoma (terminal/loop) at 6 months after initial surgery.	Patients carrying stoma 6 months after low anterior resection for rectal cancer.	6 months from the date of low anterior resection for rectal cancer
Other	The number of participants with virtual ileostomy converted to diverting ileostomy.	The virtual stoma required bedside or secondary surgery for diverting ileostomy due to complications.	Through study completion, an average of 1 year
Other	The number of patients who required secondary abdominal surgery under general anesthesia due to complications	Patients undergo second abdominal surgery for complications after low anterior resection for rectal cancer.	Through study completion, an average of 1 year
Other	Ghost ileostomy remove time	Duration of days from the date of radical resection of rectal cancer to virtual stoma removed.	During hospitalization,approximately 7 days
Other	The number of patients with complications after low anterior resection for rectal cancer.	Abdominal abscess,Anastomotic bleeding,Pelvic infection,Surgical incision infection, Peritonitis,Interventional drainage ,ileostomy wounds/abscesses/edema/dermatitis/ ulcers,Parastomal hernia ,Stoma prolapse,Anastomotic separation/poor healing, Anastomotic stenosis,Anastomotic leakage,Bowel obstruction,Anastomotic bowel necrosis ,Wound dehiscence / bleeding / sinus tract / abscess/fat liquefaction,Acute kidney injury ,Dehydration/output >1500 mL/day,Converted to permanent ileostomy,Intestinal fistula,Incisional hernia ,fecal incontinence.	Through study completion, an average of 1 year
Other	Adjuvant chemotherapy in patients after low anterior resection for rectal cancer.	Whether the patient has completed chemotherapy.	6 months from the date of low anterior resection for rectal cancer
Primary	Calculation postoperative of the Comprehensive Complication Index (CCI) for each patient	The Comprehensive Complication Index (CCI)summarises all postoperative complications based on the established Clavien-Dindo classification (ranging from mild complications not leading to a deviation from the normal clinical course (grade I) up to postoperative death (grade V)) at an individual patient level according to their grade of severity.	An average of 1 year from the date of low anterior resection for rectal cancer until the date of when the patient's condition is stabilized without complications
Secondary	Postoperative hospitalization days	Patients in the virtual stoma group who did not have a second surgery due to complications recorded days of postoperative hospitalization after low anterior resection for rectal cancer, if the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record days of postoperative hospitalization due to complications and/or reoperation since the data of low anterior resection for rectal cancer.	Through study completion, an average of 1 year
Secondary	Readmission rates	Patients in the virtual stoma group who did not have a second surgery due to complications recorded the number of hospitalization after low anterior resection for rectal cancer. If the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the number of hospitalization due to complications and/or reoperation since the data of low anterior resection for rectal cancer.	Through study completion, an average of 1 year
Secondary	The number of hospitalizations	Patients in the virtual stoma group who did not have a second surgery due to complications recorded the number of hospitalization after low anterior resection for rectal cancer. If the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the number of hospitalization due to complications and/or reoperation since the data of low anterior resection for rectal cancer.	Through study completion, an average of 1 year
Secondary	Duration of bearing the stoma (months)	If the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the duration of bearing the stoma since the data of surgery of diverting ileostomy.	Through study completion, an average of 1 year
Secondary	First hospitalization costs	Patient hospitalization costs for radical resection of rectal cancer.	During hospitalization,approximately 7 days
Secondary	Total hospitalization costs	Patients in the virtual stoma group who did not have a second surgery due to complications recorded the costs after low anterior resection for rectal cancer, if the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the costs due to complications and reoperation since the data of low anterior resection for rectal cancer.	Through study completion, an average of 1 year