{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:30:39Z","timestamp":1784032239212,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,10,29]],"date-time":"2022-10-29T00:00:00Z","timestamp":1667001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The impact of surgeon volume on 18\u2010month unclosed ileostomy rates after rectal cancer surgery has not been fully explored. The aim of this study was to describe the effect of surgeon volume and evaluate factors predictive of an unclosed ileostomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Patients undergoing anterior resection with a diverting ileostomy for rectal cancer from March 2004 to October 2018 were identified from a prospectively maintained database. The unclosed ileostomy rate was determined by those with an unclosed ileostomy at 18\u2009months. High\u2010 and low\u2010volume surgeons (HVS and LVS, respectively) were classed as those performing five or more or fewer than five rectal cancer resections per year, respectively. Data on sex, age, American Society of Anesthesiologists grade, neoadjuvant chemoradiotherapy (CRT), tumour height, T\u2010stage, anastomotic leak, surgical approach and adjuvant chemotherapy were also collected. Factors predictive of an unclosed ileostomy at 18\u2009months were explored using a multivariate binary logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 415 patients (62.4% male) with a median age of 67 were eligible for analysis. Of these, 115 (27.7%) had an unclosed ileostomy at 18\u2009months. HVS had an unclosed ileostomy rate of 24.6% (72\/292) compared with 34.9% (43\/123) for LVS. Volume was associated with an unclosed ileostomy in univariable analysis (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.032) but not in multivariate analysis (OR 1.75, 95% CI 0.92\u20133.32, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.08). Independent factors predictive of an unclosed ileostomy were anastomotic leak (OR 10.41, 3.95\u201327.0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), adjuvant chemotherapy (OR 2.23, 1.24\u20133.96, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and neoadjuvant CRT (OR 2.16, 1.15\u20135.75, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LVS were associated with a higher unclosed ileostomy at 18\u2009months compared with HVS. This study adds further weight to the call for adoption of a minimum annual case threshold in rectal cancer surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16368","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T14:19:28Z","timestamp":1665584368000},"page":"253-260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of surgeon volume on 18\u2010month unclosed ileostomy rate after restorative rectal cancer resection"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8771-158X","authenticated-orcid":false,"given":"Robert","family":"Tyler","sequence":"first","affiliation":[{"name":"Birmingham Heartlands Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Foss","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Phelan","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Radley","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Geh","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharad","family":"Karandikar","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,29]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Scottish Intercollegiate Guidelines Network (SIGN).Diagnosis and managment of colorectal cancer.2016."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15531"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2007.01456.x"},{"key":"e_1_2_12_5_1","unstructured":"Healthcare Quality Improvement Partnership.National Bowel Cancer Audit.2021."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.50340"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2006.01178.x"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2009.01815.x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2017.09.057"},{"key":"e_1_2_12_10_1","unstructured":"National Institue for Health and Care Excellence (NICE).Surgical volumes and outcomes for rectal cancer.2020."},{"key":"e_1_2_12_11_1","unstructured":"Healthcare Quality Improvement Partnership (HQIP).Hospital and surgeon\u2010volumes for rectal cancer surgery in England and implications for Wales.2022."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-018-2994-x"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2012.08.018"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000520"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13339"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31829ef472"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2013.12.016"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1463-1318.4.s1.1_78.x"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab260"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181fd2948"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-020-01968-8"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamasurg.2"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-019-1655-z"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-011-1696-1"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-008-4052-8"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2010.118"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-022-02470-3"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481908500218"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.16368","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.16368","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.16368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T08:51:16Z","timestamp":1692348676000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.16368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,29]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/codi.16368"],"URL":"https:\/\/doi.org\/10.1111\/codi.16368","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,29]]},"assertion":[{"value":"2022-07-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}