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2. A retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway

Author

Stephan Robitaille, Anna Wang, A. Sender Liberman, Patrick Charlebois, Barry Stein, Julio F. Fiore, Liane S. Feldman, and Lawrence Lee

Subjects
Surgery
Abstract

There is increasing evidence to support discharge prior to gastrointestinal recovery following colorectal surgery. Furthermore, many patients are discharged early despite being excluded from an ambulatory colectomy pathway. The objective of this study was to determine the outcomes of patients discharged early following laparoscopic colectomy in an enhanced recovery pathway (ERP).A retrospective review of all adult patients undergoing elective laparoscopic colectomy at a single university-affiliated colorectal referral center (08/2017-06/2021) was performed. Patients were included if they had undergone elective laparoscopic colectomy or ileostomy closure and excluded if they had been enrolled in an ambulatory colectomy pathway. Patients were then divided into three groups: LOS =1 day, LOS 2-3 days, and LOS 4+ days. The main outcomes were 30-day emergency room (ER) visits and readmissions. Reasons for inpatient stay per post-operative day (POD) were also recorded.A total of 497 patients were included [LOS1 n = 63 (13%), LOS2-3 n = 284 (57%), and LOS4+ n = 150 (30%)]. There were no differences in patient characteristics, diagnosis, or procedure between the groups. Patients were discharged with gastrointestinal recovery (GI-3) in 54% LOS1 vs. 98% LOS2-3 vs. 100% LOS4+ (p0.001). Shorter procedure duration, transversus abdominus plane block, and lower opioid requirements were associated with shorter LOS (p0.001). The absence of flatus was the most common reason to keep patients hospitalized: 61% on POD1, 21% on POD2, and 8% on POD3 (p0.001). There were no differences in 30-day emergency visits, or readmission between the groups. In the LOS1 group, there were no differences in outcomes between patients with full return of bowel function at discharge compared to those without.Discharge on POD1 was not associated with increased emergency department use, complications, or readmissions. Importantly, full return of bowel function at discharge did not affect outcomes. There may be potential to expand eligibility criteria for ambulatory colectomy protocol.

Published
2022

3. 2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing after outpatient breast surgery: Time for a streamlined approach?07. Trends in graduate degree types and research output for Canadian academic general surgeons08. Would you prefer to undergo breast-conserving therapy or a mastectomy for early breast cancer? Comparison of perceptions of general and plastic surgeons09. Lack of representation of women and BIPOC individuals in Canadian academic surgery10. 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Impact of rectal cancer on bowel dysfunction before treatment and its relationship with post-treatment function18. Canadian cost–utility analysis of artificial-intelligence-assisted colonoscopy for adenoma detection in fecal immunochemical-based colorectal cancer screening19. A comparison of outcomes following intracorporeal and extracorporeal anastomotic techniques in laparoscopic right colectomies20. Assessment of metabolic signatures using desorption electrospray ionization mass spectrometry (DESI) and rapid evaporative ionization mass spectrometry (REIMS) of rectal cancer samples to assist in determining treatment response21. The association between hospital characteristics and minimally invasive rectal cancer surgery: a population-based study22. Cancer centre level designation and the impact on treatment and outcomes in those with rectal cancer: a population-based study23. 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Extended duration perioperative thromboprophylaxis with low-molecular-weight heparin to improve disease-free survival following surgical resection of colorectal cancer: a multicentre randomized controlled trial (PERIOP-01 Trial)49. Three-stage versus modified 2-stage ileal pouch anal anastomosis: perioperative outcomes, function and quality of life50. Compliance with extended venous thromboembolism prophylaxis in rectal cancer51. Extended-duration venous thromboembolism prophylaxis after diversion in rectal cancer52. Financial and occupational impact of low anterior resection syndrome: a qualitative study53. Nonoperative management for rectal cancer: patient perspectives54. Trends in ileostomy-related emergency department visits for rectal cancer patients55. Long-term implications of treatment of fecal incontinence: a single Canadian centre’s retrospective cohort study: a 17-year follow-up56. Externally benchmarking colorectal resection outcomes in our province against the ACS NSQIP risk calculator: identifying opportunities for improvement57. Externally benchmarking our provincial colectomy outcomes against the ACS NSQIP using the Codman Score: to identify possible opportunities for improvement of outcomes58. Rural v. urban documentation of recommended practices for optimal endoscopic colorectal lesion localization01. Incidence of in-hospital opioid use and pain after inguinal hernia repair02. Ventral hernia repair following liver transplantation: outcome of repair techniques and risk factors for recurrence01. Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients02. Patient selection and 30-day outcomes of SADI-S compared to RYGB: a retrospective cohort study of 47 375 patients03. New persistent opioid use following bariatric surgery: a systematic review and pooled proportion meta-analysis04. 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Author

Luckshi Rajendran, Jorge Roldan, Andrew Lagrotteria, Helia Nabavian, Alice Zhu, Evelyn Waugh, Alex Lee, Adriana Workewych, Sarah Mansouri, Marco Claasen, Nawal Amhis, Tori Lenet, Richard Gilbert, Woo Jin Choi, Jesse Zuckerman, Christopher Griffiths, Zuhaib Mir, Nic Jette, Kevin Verhoeff, Jieun Newman-Bremang, Ko Ta Chen, Erika Schmitz, Shawn Khan, Katelynn Tang, Ashley Eom, Michael A. D’Elia, Léamarie Meloche-Dumas, Shelly Luu, Deanna Ng, Cecily Stockley, Dhruvin Hirpara, Ananya Gopika Nair, Victoria Ivankovic, Muriel Brackstone, David Cyr, Bianka Saravana-Bawan, Akie Watanabe, Makena Pook, Matthew Castelo, Nader Hanna, Valentin Mocanu, Intekhab Hossain, Cypriana Koziak, Ekaterina Kouzmina, Karim Ramji, Wenjing He, Jessica Trac, Alexandra Chow, Eileen Roach, Yung Lee, Hilalion (San) Ahn, Warren Sun, Mirza Shaharyar Ahmad, Ting Li, Marta Whyte, Kieran Purich, Olivier Mailloux, Khadija Nasser, Megan Melland-Smith, Marguerite Mainprize, Charbel El-Kefraoui, Philip Lagace, Natasha Caminsky, Armaghan Alam, Yosef Levin, Jessica Hopkins, Terry Phang, Rebecca C. Auer, Geneviève Morin, Alexa Ehlebracht, Roy Hajjar, Jessica Lie, Vanessa Wiseman, Victoria Baronas, Alon Wachtel, Michael Fares Maalouf, Sunil Patel, Zubair Bayat, Tiffany Paradis, Jeongyoon (Jenny) Moon, James Holden, Lisa Zhang, Garrett Johnson, Simarpreet Ichhpuniani, Laura Baker, Kelly Brennan, Sydney Selznick, Hamid Sadri, Stephan Robitaille, Lawrence Lee, Tyler McKechnie, Sydney Candy, Sahil Sharma, Richard Garfinkle, Antonio Caycedo-Marulanda, Jay Lee, Emily Mackay, Jacob Alaichi, Linda Chang Qu, Biniam Kidane, Jacob A. Alaichi, Ge Shi, Lyndsay Harrison, Pooja Patel, Sami A. Abdul, Negar Ahmadi, Riley Bowker, Adom Bondzi-Simpson, Gileh-Gol Akhtar-Danesh, Evan Barber, Uzair Jogiat, Anna L. McGuire, Yogita S. Patel, Bright Huo, Joshua Keogh, Christina Schweitzer, Zarrukh Baig, Annie Lalande, Karina Spoyalo, Nathan How, Christina Lee, Kameela Alibhai, Ananya Srivastava, Brent Hopkins, Jillian Tweedy, Alexandra Allard-Coutu, Thomas Nixon, Jeremy Drung, Simon Laplante, Mostafa Alhabboubi, Patrick Murphy, Shirley Xiaoxuan Deng, Nori Bradley, Kelly Vogt, Lily Park, Hala Muaddi, Brianna Greenberg, Armin Rouhi, Uyen Do, Jeff Metz, Samuel Skinner, Christine Li, Emma Imbert, Jessica Henley, Nada Gawad, Saba Balvardi, Lyndsay T. Glass, Keegan Guidolin, Julian Daza, Morgan Schellenberg, Ali Safar, Rahim Valji, Samantha Albacete, Julie La, Nawaf Abu-Omar, Élise Di Lena, Yasser Selim, Nadia Safa, Sid Rahman, Pepa Kaneva, Liane Feldman, Nathan Ginther, Dilip Gill, Zaini Sarwar, Carlos Verdiales, Mike Moser, Breanna Fang, Jerry Dang, Noah Switzer, Daniel Birch, Shahzeer Karmali, Anood Alqaydi, Xuejiao Wei, Genevieve Digby, Susan Brogly, Shaila Merchant, Alexander Miles, Janice Y. Kung, A.M. James Shapiro, David L. Bigam, Ashlee Matkin, Danielle Dumestre, Lashan Peiris, Simon Turner, Brett Mador, Steffane McLennan, Atif Jastaniah, Natthida Owattanapanich, Areg Grigorian, Lydia Lam, Jeffry Nahmias, Kenji Inaba, Panagiotis Liasidis, Demetrios Demetriades, Elizabeth R. Benjamin, Shaun Cowan, Monica D. Wong, Brent Emigh, Lindsey Karavites, Damon H. Clark, Geoffrey A. Anderson, Vincent Cheng, Lee Myers, Brian Cuthbertson, Paul Myles, Mark Shulman, Duminda Wijeysundera, Patrick B. Murphy, Laura Allen, Kathryn Minkhorst, Dillon Bowker, Ephraim S. Tang, Kenneth Leslie, Jeffrey E. Hawel, Odelle Ma, Raveena Dhaliwal, Matt Strickland, Jason Park, Ashley Vergis, Lawrence Gillman, Justin Rivard, Justin Lin, Anudari Zorigtbaatar, Minahil Nadeem, Tarek Ibrahim, Zdenka Neilson, Kyung Young (Peter) Kim, Sami Chadi, Fayez Quereshy, Malcolm Davidson, Emily Friedrich, Caitlin Champion, Koorosh Semsar-Kazerooni, Carmen Mueller, Melina Vassiliou, Mohammed Al Mahroos, Julio Fiore, Kevin Schwartzman, Blaire Anderson, Ryan Daniel, Colin Kruse, Marc Levin, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Christopher Povolo, Mohit Bhandari, Esther Lee, Dasan Sydora, Darrell Boone, Stephanie Roberts, Duncan McGrouther, Paul Manuel, Mark Dykstra, Haili Wang, Ryan Snelgrove, Troy Perry, Matthew Strickland, Stephanie Skanes, Joseph Tropiano, Daniel McIsaac, Alan Tinmouth, Julie Hallet, Stuart Nicholls, Dean Fergusson, Guillaume Martel, Andrea Patey, Reza Naqvi, Ruediger Noppens, Jeff Hawel, Ahmad Elnahas, Christopher Schlachta, Nawar Alkhamesi, Ranjeeta Mallick, Julie Shaw, Tahereh Najafi, Fateme Rajabiyazdi, Natasha Barone, Hiba Elhaj, Philip Nguyen-Powanda, Gabriele Baldini, Deng Mapiour, Michael Kim, Ashlie Nadler, Theres Stukel, Charles De Mestral, Avery Nathens, Stephen Pautler, Bobby Shayegan, Wael Hanna, Rodney Breau, Laura Hopkins, Timothy Jackson, Paul Karanicolas, Sam Ali, Victoria Archer, Zacharie Cloutier, Dexter Choi, Pablo Serrano, J. Andrew McClure, Philip Jones, Marko Mrkobrada, Suzanne Flier, Blayne Welk, Luc Dubois, Kosar Khwaja, Lily Tung, Morad Hameed, Jacinthe Lampron, Carlos Garcia-Ochoa, Paul Engels, Gaurav Talwar, Sam Minor, Brad Moffat, Neil Parry, Tega Ebeye, Bree T. Sharma, Anas Samman, Amna Zulfiqar, Roderick H. Purzner, Brittany Greene, Melanie Tsang, Shiva Jayaraman, Chad G. Ball, Rahima Nenshi, Sandy Widder, Sender Liberman, Evan Wong, Talat Chughtai, Joel Turner, Sam Wiseman, Jennifer Li, Nicole Mak, Babak Namazi, Parmiss Kiani, Daniel Hashimoto, Adnan Alseidi, Mauricio Pasten, L. Michael Brunt, Sujata Gill, Brian Davis, Matthew Bloom, Luise Pernar, Allan Okrainec, Amin Madani, Trevor Hamilton, Kylie Nabata, Jenny W. Zhang, Darren Zhao, Phil Dawe, Ken Leslie, Barbara Heller, Victoria Wright, Wanjae Cho, Michael Wong, Kevin Singh, Émilie Comeau, Yves Collin, Sonia Cheng Oviedo, Tyler Lamb, Morgann Reid, Anastasia Turner, Kimberly Bertens, Janelle Rekman, Fady Balaa, Katerina Neumann, Geoff Porter, Iris Teo, Catherine L. Forse, Reilly Musselman, Lily Grozman, Nawaf Alshawan, Shannon Fraser, Simon Bergman, Jean-Sebastien Pelletier, Tsafrir Vanounou, Evan G. Wong, Brodie Nolan, Lyon Qiao, James Jung, Isabelle Raîche, Heather McDonald, Rona Cheifetz, Philippa Hawley, Zachary Rehany, Mehrshad Bakhshi, Tarek Razek, Jeremy Grushka, Nathalie Boulanger, Larry Watt, Alexandra Vivier, Greg Clark, Paola Fata, Dan Deckelbaum, Kevin Ren, Yuan Qiu, Karyssa Hamann, Andrea MacNeill, Stephanie Alexis, Keiko Patterson, Neha Gadhari, Jiaying Zhao, Rubia Ahmed, Ameer Farooq, Ahmer Karimuddin, Allison Chhor, Housne Begum, Noori Akhtar-Danesh, Christian Finley, Daria Manos, Zhaolin Xu, Kara Matheson, Samuel Chun, John Fris, Alison Wallace, Daniel French, Jean-Marc Baste, Yaron Shargall, Thomas K. Waddell, Kazuhiro Yasufuku, Tiago N. Machuca, Feng Xie, Lehana Thabane, Wael C. Hanna, Marla K. Beauchamp, Joshua Wald, Lawrence Mbuagbaw, Brenda L. Key, Sheryl M. Green, Abdollah Behzadi, Laura Donahoe, Awrad Nasralla, Julius Poon, Najib Safieddine, Nazgol Seyednejad, Iran Tavakoli, Sohat Sharma, Roy A. Hilzenrat, Melissa McConechy, Ingrid Frank, Curtis Hughsman, Stephen Yip, James J. Choi, John Yee, Hannah Sasewich, Vickie Baracos, Dean Eurich, Heather Filafilo, Eric Bedard, Yasith Samarasinghe, Janhavi Patel, Adree Khondker, Nadeesha Samarasinghe, John Agzarian, Melissa Whidden, Francisco Aguirre, Andrew Graham, Joycelyne Ewusie, Shargall Yaron, Melanie Keshishi, Yonas Ademe, Ayalew Tizazu, Marci Rose, Sameena Uddin, Michael Ko, Jimmy Ddamba, Sayf Gazala, Carmine Simone, Frances Wright, Patrick J. Villeneuve, Sebastian Gilbert, Sudhir Sundaresan, Andrew J.E. Seely, Donna E. Maziak, Madelaine Plourde, Donna Turner, Jolie Ringash, Douglas Manuel, Vaibhav Gupta, Kathleen Decker, Laura Davis, Gail Darling, Carolyn Compton, Natalie Coburn, Randy Boyes, Michael Pugliese, Alyson Mahar, Amy Hsu, Andrew Kokavec, Edward Ho, Ryan Waterman, Edward Wang, Kiera Harnden, Richard Malthaner, Rahul Nayak, Mehdi Qiabi, Yogita Patel, Forough Farrokhyar, Marko Simunovic, Stephen Gowing, Richard Liu, Sadeesh Srinathan, Larry Tan, Peter Malik, Umeed Fahim, Ajmal Hafizi, Ahmad S. Ashrafi, Nalin Amin, Courtney Streu, Clarence Wong, Dan Schiller, Colin Sue-Chue-Lam, Lawrence Paszat, Adena Scheer, Bettina Hansen, Teruko Kishibe, Nancy Baxter, Emma Neary, Chris Verschoor, Luis Romagnolo, Carl Brown, Manoj Raval, Elena Vikis, George Melich, Christopher Booth, Weidong Kong, Chad McClintock, Clare Bankhead, Carl Heneghan, Jennifer Flemming, Maya Djerboua, Sulaiman Nanji, Marie Demian, Sarah Sabboobeh, Jeongyoon Moon, Michael Hulme-Moir, A. Sender Liberman, Stan Feinberg, Dana M. Hayden, Sami A. Chadi, Sebastian Demyttenaere, Louise Samuel, Nevart Hotakorzian, Laurence Quintin, Nancy Morin, Gabriela Ghitulescu, Julio Faria, Carol-Ann Vasilevsky, Marylise Boutros, Tyler Mckechnie, Jigish Khamar, Shaylan Govind, Justin Lu, Luisa Cardenas, Daniel Schep, Raimond Wong, Oren Levine, Barry Stein, Patrick Charlebois, Gerald Fried, Anna Wang, Julio F. Fiore, Alan Barkun, Jordan Levy, Ruxandra Bogdan, Jeffrey Hawel, Nawar A. Alkhamesi, Christopher M. Schlachta, Natasha Iaboni, David Hurlbut, Martin Kaufmann, Kevin Yi Mi Ren, Amoon Jamzad, Parvin Mousavi, Gabor Fichtinger, Christopher J.B. Nicol, John F. Rudan, Sunil V. Patel, Chris Booth, Alexandra Donaldson, Sanjay Murthy, Jeremy Biro, Harminder Singh, Ramzi Helewa, Kristin Reynolds, Kathryn Sibley, Malcolm Doupe, David Hochman, Sophie Dell’Aniello, Phyllis Zelkowitz, Paul Brassard, Amine Zoughlami, Wusiman Abibula, Alex Amar, Théa Araji, Allison Pang, Mahalia Oliver, Liane S. Feldman, Erin Kennedy, Charles Victor, Anand Govindarajan, Shaila J. Merchant, Ruxandra Penta, Julio Flavio Fiore, Nathalie Wong-Chong, Daniel Marinescu, Sahir Bhatnagar, Arif Arif, Gale Ladua, Eric Bhang, Fergal Donellan, Heather Stuart, Jonathan Loree, Peter Hugh MacDonald, Kathleen Wattie Barnett, Amandeep Ghuman, Hyea Min Yoon, Gabriela Fragoso, Manon Oliero, Annie Calvé, Hervé Vennin Rendos, Emmanuel Gonzalez, Nicholas J.B. Brereton, Thibault Cuisiniere, Claire Gerkins, Souad Djediai, Borhane Annabi, Khoudia Diop, Bertrand Routy, Patrick Laplante, Jean-François Cailhier, Nassima Taleb, Hefzi Alratrout, François Dagbert, Rasmy Loungnarath, Herawaty Sebajang, Frank Schwenter, Ramses Wassef, Richard Ratelle, Eric Debroux, Carole Richard, Manuela M. Santos, Doulia Hamad, Hatim Alsulaim, Olivia Monton, Mohammed Alqahtani, Terry Zwiep, Joshua Greenberg, Lara Williams, Isabelle Raiche, Kednapa Thavorn, Husein Moloo, Janyssa Charbonneau, Xavier Paré, Jonathan Frigault, François Letarte, Michael Ott, Shady Ashmalla, Joel Weaver, Vicky Tagalakis, Peter Stotland, Gregoire LeGal, Silvana Spadafora, Steven Maclellan, Daniel Trottier, Derek Jonker, Timothy Asmis, Timothy Ramsay, Marc Carrier, Delaram Shojaei, Ali Motamedi, Anu Ghuman, Don Buie, Nasra Al Busaidi, Farhad Udwadia, Nathalie McFadden, Richard Spence, Greg Hirsch, Ayse Yilbas, Fernando Spencer Netto, Joel Katz, Bree Sharma, Usman Khan, Markus Selzner, Hillary Wilson, Hayley Forbes, Janice Kung, Nicolas Tassé, André Tchernof, Mélanie Nadeau, Philip Dawe, Andrew Beckett, Laurent Biertho, Andrea Lin, Daniel W. Birch, Noah J. Switzer, Melinda Fowler-Woods, Amanda Fowler-Woods, Geraldine Shingoose, Andrew Hatala, Felicia Daeninck, Krista Hardy, Kathleen Clouston, Estifanos Debru, Christopher De Gara, Jennifer Halasz, Aliyah Kanji, Renuca Modi, Jeffrey Gu, Amer Jarrar, Nicole Kolozsvari, Lucy Chen, Akithma Hapugall, Arshia Javidan, Shannon Stogryn, Azusa Maeda, Michael Balas, Denise Gee, Matthew Hutter, Ozanan Meireles, Vanessa Boudreau, Mehran Anvari, Pouya Iranmanesh, Karen Barlow, Tyler Cookson, Rafik Bolis, Harsha Shanthanna, Jonah Shiroky, Shaidah Deghan, Boris Zevin, Jane Brodie, Erin O’Brien, Katherine Tedman-Aucoin, Diana Lawlor, Raleen Murphy, Laurie Twells, David Pace, James Ellsmere, Bradley Evans, Terry Zhang, Edward Deehan, Dina Kao, Naomi Hotte, Kalutota Samarasinghe, Jens Walter, Karen Madsen, Erin Williams, Adam Fundytus, Wiley Chung, Tahereh Najafi Ghezeljeh, Maxime Lapointe-Gagner, Rinku Sutradhar, Barbara Haas, Matthew Guttman, Antoine Eskander, Tyler Chesney, Bourke Tillman, Victoria Zuk, Wing Chan, Filomena Servidio-Italiano, Gonzalo Sapisochin, Eitan Prisman, Elliot Mitmaker, Ross Walker, Jonn Wu, Anne Nguyen, Michael Gupta, Jesse Pasternak, Omar Vergara-Fernandez, Amanpreet Brar, James Conner, Richard Kirsch, Mantaj Brar, Robert Gryfe, Helen MacRae, Zane Cohen, Robin McLeod, Carol Swallow, Farhad Ghasemi, Megan Delisle, Dawn Stacey, Jad Abou-Khalil, Brittney Dingley, Kristen McAlpine, Carolyn Nessim, Shaheer Tadros, Rebecca Auer, David Lim, Felicia Pickard, Alexander Mathieson, Michael Hogan, Melanie Seal, Belkacem Acidi, Wendy Johnston, Dario Callegaro, Savtaj Brar, Rebecca Gladdy, Peter Chung, Charles Catton, Korosh Khalili, Charles Honore, Ning Fu, Karineh Kazazian, Karina Pacholczyk, Jossie Swett-Cosentino, Paul Savage, Yukiko Shibahara, Sangeetha Kalimuthu, Osvaldo Espin-Garcia, Jonathan Yeung, Frédéric Mercier, Victoria Barabash, Calvin Law, Simron Singh, Sten Myrehaug, Narry Muhn, Peter Lovrics, Daniel Koerber, Eisar Al-Sukhni, Sameer Apte, Judy Ban, Leo Chen, Elaine McKevitt, Rebecca Warburton, Jin-Si Pao, Carol Dingee, Urve Kuusk, Amy Bazzarelli, Nicole Look Hong, Anna Gagliardi, Bryanna Nyhof, Braulio Marfil-Garza, Gurpal Sandha, David Cooper, Khaled Dajani, David Bigam, Tatsuya Kin, Anna Lam, Doug O’Gorman, Peter Senior, Camillo Ricordi, Michael Moser, Henry Lam, Diederick Jalink, Sean Bennett, Betty Zhang, Kasia Tywonek, Brandon Meyers, Risa Shorr, Alice Wei, Yosuf Kaliwal, Phil Williams, Tommy Ivanics, Marina Englesakis, Steven Gallinger, Alexandre Brind’Amour, Christian Toso, Rene Adam, Jan Ijzermans, Wojtek Polak, Maxime Léveillé, Christine Lawson, Lee-Hwa Tai, Ahmed Al-Arnawoot, Richard Mimeault, Chris Zhang, Madeline Lemke, Juan Glinka, Anton Skaro, Ephraim Tang, Lev Bubis, Melanie E. Tsang, Olivia Ganescu, Jean-Sébastien Pelletier, and Marco P.A.W. Classen

Subjects
Surgery
Published
2022

4. Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life?

Author

Anna, Wang, Stephan, Robitaille, Sender, Liberman, Liane S, Feldman, Julio F, Fiore, and Lawrence, Lee

Subjects
Gastroenterology, Surgery
Abstract

Bowel dysfunction after rectal cancer surgery is common, but its effect on health-related quality of life (HRQOL) is complex. Objective measures of bowel function may not be a good representation on the actual impact on HRQOL. Therefore, the objective of this study is to determine whether there are differences between patient-reported bowel-related impairment versus a standardized measure of bowel dysfunction on HRQOL.A prospective database starting in September 2018 of adult patients who had undergone sphincter preserving rectal cancer surgery up to October 2021 was queried. Patients were excluded if they had local recurrence, metastasis, persistent stoma, or had less than 1-year follow-up. Patients were administered the study instruments at their standard surveillance visit: patient-reported bowel-related quality of life(BQOL) impairment, HRQOL using the Short Form-36 (SF-36), and bowel dysfunction using the low anterior resection syndrome(LARS) score.Overall, 136 patients were included. There were 43% with no LARS, 22% with minor LARS, and 35% with major LARS. For the BQOL, 26% of subjects reported no impairment, 57% minor impairment, and 17% major impairment. There was a high proportion of discordance between BQOL and LARS, with 23% minor or major LARS in patients with no BQOL impairment, and 32% with no or minor LARS with major BQOL impairment. The BQOL was associated with more changes in SF-36 scores compared to the LARS score.The patient-reported BQOL is likely to be a more relevant outcome of interest to patients than the objective LARS score. This has important implications for shared decision-making for rectal cancer treatments.

Published
2022

6. Predictors of pre- and post-treatment bowel dysfunction severity in patients with rectal cancer

Author

Stephan Robitaille, Anna Wang, Sender Liberman, Patrick Charlebois, Barry Stein, Julio F. Fiore, Liane S. Feldman, and Lawrence Lee

Subjects
Surgery
Abstract

Treatment of rectal cancer is frequently associated with low anterior resection syndrome. However, data concerning the contribution rectal tumors have on pretreatment bowel-dysfunction is scarce. We sought to evaluate the impact of the untreated rectal cancer on bowel-dysfunction and the relationship of pretreatment and post-treatment function.A prospective database of adults with rectal cancer at a single university-affiliated colorectal referral center from August 2018 to March 2022 was queried. Bowel-dysfunction was measured using the low anterior resection syndrome score questionnaire (categorized as no, minor, or major low anterior resection syndrome) which was provided to patients at their primary visit, and after treatment. Patients were included if they underwent rectal cancer treatment and had pre- and post-treatment low anterior resection syndrome measurements. Observed low anterior resection syndrome scores were compared to normative low anterior resection syndrome data for age and sex-specific distributions from published data. Multiple multinomial regression compared pre- and post-treatment low anterior resection syndrome scores.Overall, 121 patients were included with mean age 62.0 years (standard deviation 12.3), 74% male, and mean tumor height 8.7 cm (standard deviation 5.72). The proportion of pretreatment observed low anterior resection syndrome were 48% no low anterior resection syndrome, 28% minor, and 24% major. Male and older patients were more likely to have worse than predicted low anterior resection syndrome categories (P.05). On average, low anterior resection syndrome category did not change after treatment (P = .618) and pretreatment low anterior resection syndrome category was a significant independent predictor of post-treatment category (P = .037).Pretreatment bowel-dysfunction in rectal cancer patients is common and significantly worse than predicted for older and male patients. Importantly, pretreatment bowel-dysfunction predicted postoperative function. These results may better inform the shared decision-making process.

Published
2022

8. A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial

Author

Dan Moldoveanu, Patrick Charlebois, Lawrence Lee, Barry Stein, Juan Mata, Julio F. Fiore, Liane S. Feldman, Nicolò Pecorelli, Alexandre Gosselin-Tardiff, Saba Balvardi, Mohsen Alhashemi, Sender Liberman, Stephan Robitaille, Pepa Kaneva, Mata, J., Pecorelli, N., Kaneva, P., Moldoveanu, D., Gosselin-Tardiff, A., Alhashemi, M., Robitaille, S., Balvardi, S., Lee, L., Stein, B. L., Liberman, S., Charlebois, P., Fiore, J. F., and Feldman, L. S.

Subjects
Technology, medicine.medical_specialty, Mobile application, 030230 surgery, Recovery pathways, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Patient Education as Topic, law, Surveys and Questionnaires, Outcome Assessment, Health Care, medicine, Humans, Patient participation, Colorectal, business.industry, Behavior change, Behavior change methods, Mobile Applications, Colorectal surgery, Telemedicine, Physical therapy, Patient Compliance, 030211 gastroenterology & hepatology, Surgery, Health education, business, Enhanced Recovery After Surgery, Colorectal Surgery, Abdominal surgery, Patient education
Abstract

Background: Increased adherence with enhanced recovery pathways (ERP) is associated with improved outcomes. However, adherence to postoperative elements that rely on patient participation remains suboptimal. Mobile device apps may improve delivery of health education material and have the potential to foster behavior change and improve patient compliance. The objective of this study was to estimate the extent to which a novel mobile device app affects adherence to an ERP for colorectal surgery in comparison to standard written education. Methods: This was a superiority, parallel-group, assessor-blind, sham-controlled randomized trial involving 97 patients undergoing colorectal resection. Participants were randomly assigned with a 1:1 ratio into one of two groups: (1) iPad including a novel mobile device app for postoperative education and self-assessment of recovery, or (2) iPad without the app. The primary outcome measure was mean adherence (%) to a bundle of five postoperative ERP elements requiring patient participation: mobilization, gastrointestinal motility stimulation, breathing exercises, and consumption of oral liquids and nutritional drinks. Results: In the intervention group, app usage was high (94% completed surveys on POD0, 82% on POD1, 72% on POD2). Mean overall adherence to the bundle on the two first postoperative days was similar between groups: 59% (95% CI 52–66%) in the intervention group and 62% (95% CI 56–68%) in the control group [Adjusted mean difference 2.4% (95% CI − 5 to 10%) p = 0.53]. Conclusions: In this randomized trial, access to a mobile health application did not improve adherence to a well-established enhanced recovery pathway in colorectal surgery patients, when compared to standard written patient education. Future research should evaluate the impact of applications integrating novel behavioral change techniques, particularly in contexts where adherence is low.

Published
2018

9. Methylmercury alters glutathione homeostasis by inhibiting glutaredoxin 1 and enhancing glutathione biosynthesis in cultured human astrocytoma cells

Author

Ryan J. Mailloux, Hing Man Chan, and Stephan Robitaille

Subjects
0301 basic medicine, GPX1, Antioxidant, medicine.medical_treatment, Glutathione reductase, Astrocytoma, Toxicology, medicine.disease_cause, Central Nervous System Neoplasms, 03 medical and health sciences, chemistry.chemical_compound, Downregulation and upregulation, Glutaredoxin, Cell Line, Tumor, medicine, Homeostasis, Humans, Glutaredoxins, Mercury Poisoning, Nervous System, Neurons, Dose-Response Relationship, Drug, Glutathione Disulfide, Chemistry, General Medicine, Glutathione, Methylmercury Compounds, 3. Good health, Oxidative Stress, 030104 developmental biology, Biochemistry, Glutathione disulfide, Oxidation-Reduction, Protein Processing, Post-Translational, Oxidative stress
Abstract

Methylmercury (MeHg) is a neurotoxin that binds strongly to thiol residues on protein and low molecular weight molecules like reduced glutathione (GSH). The mechanism of its effects on GSH homeostasis particularly at environmentally relevant low doses is not fully known. We hypothesized that exposure to MeHg would lead to a depletion of reduced glutathione (GSH) and an accumulation of glutathione disulfide (GSSG) leading to alterations in S-glutathionylation of proteins. Our results showed exposure to low concentrations of MeHg (1μM) did not significantly alter GSH levels but increased GSSG levels by ∼12-fold. This effect was associated with a significant increase in total cellular glutathione content and a decrease in GSH/GSSG. Immunoblot analyses revealed that proteins involved in glutathione synthesis were upregulated accounting for the increase in cellular glutathione. This was associated an increase in cellular Nrf2 protein levels which is required to induce the expression of antioxidant genes in response to cellular stress. Intriguingly, we noted that a key enzyme involved in reversing protein S-glutathionylation and maintaining glutathione homeostasis, glutaredoxin-1 (Grx1), was inhibited by ∼50%. MeHg treatment also increased the S-glutathionylation of a high molecular weight protein. This observation is consistent with the inhibition of Grx1 and elevated H2O2 production however; contrary to our original hypothesis we found few S-glutathionylated proteins in the astrocytoma cells. Collectively, MeHg affects multiple arms of glutathione homeostasis ranging from pool management to protein S-glutathionylation and Grx1 activity.

Published
2015

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