Effects of hospital-family holistic care model on the health outcome of patients with permanent enterostomy based on the theory of 'Timing It Right'.

AIMS AND OBJECTIVES: To explore the effects of hospital-family holistic care model based on 'Timing It Right' on the health outcome of patients with permanent colostomy. BACKGROUND: Colorectal cancer is a common malignant tumour of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5-year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy. METHODS: A randomised controlled trial was conducted, and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care follow-up and hospital-family holistic care intervention based on 'Timing It Right', while the control group received routine care and follow-up. The resilience, self-care ability, complications and life quality of patients with permanent enterostomy were compared between two groups before intervention, at discharge, 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (see Appendix S1). RESULTS: A total of 108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs. 7.406, t = 4.933 vs. 8.611, p < .05), while the complications in the intervention group were significantly lower than that in the control group (25.5% vs. 41.51%, 14.45% vs. 30.19%; p < .05). The self-care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs. 3.656 vs. 6.273, p < .05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience, self-care ability, complications and quality of life between the two groups at different observation points (p < .01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35 ± 4.25 vs. 60.45 ± 8.42, p < .01). CONCLUSIONS: The hospital-family holistic care model based on 'Timing It Right' can effectively improve the psychological resilience, self-care ability and quality of life; reduce complications; and improve the health outcomes of patients with permanent enterostomy. RELEVANCE TO CLINICAL PRACTICE: Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital-family holistic care model based on 'Timing It Right' can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application.

Effects of lavender essential oil for colorectal cancer patients with permanent colostomy on elimination of odor, quality of life, and ostomy adjustment: A randomized controlled trial.

PURPOSE: To examine the effects of the addition of lavender essential oil to the colostomy bag of the patients with permanent colostomy on the elimination of odor, quality of life, and ostomy adjustment. METHODS: As a parallel group, single-blinded randomized controlled trial with repeated measures, this study was conducted between November 2016 and February 2018. Patients with a permanent colostomy that had opened at least three months before the study were stratified according to age and sex and were randomized according to days of week. The study sample included 15 patients in the experimental group and 15 in the control group. Patients in the experimental group used lavender essential oil in the ostomy bag, and patients in the control group continued their routine practices about nutrition and stoma care for 1 month. RESULTS: There were no statistically significant differences in demographic characteristics between the experimental and control groups (p > 0.05). As compared with the control group patients, the experimental group patients who used lavender essential oil in the ostomy bag experienced statistically significant less odor, a higher quality of life, and better adjustment to ostomy (all p < 0.05). CONCLUSIONS: The use of lavender essential oil in the ostomy bag is a simple, low-cost, easy-to-use, and natural method that is effective for increasing both ostomy adjustment and quality of life levels and for eliminating odor in permanent colostomy patients.

Long-term outcomes of a Malone antegrade continence enema (MACE) for the treatment of fecal incontinence or constipation in adults.

PURPOSE: The aim of the study was to assess the long-term outcome of a Malone antegrade continence enema (MACE) procedure for fecal incontinence or constipation in adults. METHODS: This retrospective single-center study assessed the long-term outcome and quality of life (QoL) of patients who underwent a MACE procedure between 2005 and 2014 at the Maastricht University Medical Centre. Success rate was quantified by using Malone's continence scale. Quality of life was assessed by validated questionnaires covering general quality of life (SF-36 and Karnofsky scale), current pain level (visual analog scale), fecal incontinence (Vaizey incontinence survey), or constipation (Cleveland Clinic Constipation Score). RESULTS: Based on patients' records, 22 out of 30 patients (73%; 95% CI 54-87%) were still using their MACE. Mean follow-up was 43 months (SD 25.9) since time of surgery. According to the Malone continence scale, the overall success rate was 37% (95% CI 20.0-53.3). Nine patients developed a postoperative complication. Eighteen out of 22 patients (13 with constipation and 5 with fecal incontinence) returned the QoL questionnaires (82% response rate). Long-term quality of life of patients with a MACE did not differ from the general Dutch population. CONCLUSIONS: In our cohort of patients with fecal incontinence or constipation, MACE resulted in a disappointed overall success rate of 37%. However, it may be indicated in patients who do not prefer more invasive surgical procedures or a definite stoma. The success and morbidity rate should be thoroughly discussed with the patients preoperatively.

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. 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.

The Effect of Colostomy and Ileostomy on Acts of Worship in the Islamic Faith.

PURPOSE: The aim of this study was to determine the impact of colostomy and ileostomy on Muslim patients' acts of worship. DESIGN: This was a cross-sectional, descriptive study. SUBJECTS AND SETTING: The research setting was a stoma therapy unit of a 500-bed capacity training and research hospital in Ankara, Turkey. The study sample comprised 150 patients with colostomies (40.7%) or ileostomies (59.3%); their mean age was 51.6 ± 12.9 (mean ± standard deviation), more than half (60.7%) were men, and 84.7% were married. METHODS: Participants were queried about specific religious practices following ostomy surgery including those related to salat, fasting, and pilgrimage. Data were collected using forms specifically designed for this study; respondents were interviewed either face-to-face or via telephone. Descriptive statistics were used to characterize the influence of a fecal ostomy on specific religious activities. RESULTS: Participants reported decreasing the frequency of daily and Friday prayers (25.2% and 22.7%, respectively) or stopped practicing these activities all together (12.0% and 14.0%, respectively). Respondents tended to increase the frequency of acts of absolution while reducing acts of fasting. Perceptions of cleanliness, central to performance of salat within the Islamic faith, emerged as a central concern. CONCLUSIONS: Ostomy surgery influences multiple religious acts practiced by Muslims. Awareness of the potential impact of a fecal ostomy on religious acts within the Islamic faith, combined with specialized education about spiritual practices delivered by the WOC nurse or a knowledgeable resource person, is strongly recommended for all persons following ostomy surgery.

Use of Antegrade Continence Enema for the Treatment of Fecal Incontinence and Functional Constipation in Adults: A Systematic Review.

BACKGROUND: Antegrade continence enema is a proximal colonic stoma that allows antegrade lavage of the colon for the treatment of fecal incontinence and functional constipation. Its role in the treatment of these conditions in adults has not been established. OBJECTIVE: This review aimed to evaluate the clinical response and complications of antegrade continence enema in the adult population. DATA SOURCES: A systematic literature search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 1980 to October 2013 was conducted. STUDY SELECTION: Studies reporting clinical outcomes of antegrade continence enema in adult patients were considered. Only studies with participants aged 16 years and older were selected. INTERVENTION(S): Use of the antegrade continence enema for the treatment of constipation and incontinence in adults was investigated. MAIN OUTCOME MEASURES: The primary outcome was the number of patients irrigating their stoma. Secondary outcomes included the incidence of stoma stenosis, assessment of functional outcome, and evaluation of quality of life. RESULTS: Overall, 15 studies were selected, describing outcomes in 374 patients. All of the reports were observational cross-sectional studies, and 4 were prospective. The number of participants still using their stoma ranged from 47% to 100% over a follow-up period of 6 to 55 months. Eleven studies reported achievement of full continence in 33% to 100% of patients. Four studies described functional outcomes, and 7 studies reported a wide range of patient satisfaction. The rate of stoma stenosis varied from 8% to 50%. LIMITATIONS: There were considerable heterogeneities within and across studies. Most studies were of poor quality, as reflected in the Methodological Index for Nonrandomized Studies score. CONCLUSIONS: Antegrade continence enema has been reported as an acceptable treatment of both functional constipation and fecal incontinence in adults across several analyses. There is wide variation regarding outcome measures. Larger prospective studies are required to assess the role of antegrade continence enema in the adult population.

[Therapeutic education at the heart of the patient treatment pathway]. / L'education thérapeutique au coeur du parcours de soins du patient.

The surgical treatment of bowel cancer often results in a digestive stoma, either temporary or permanent. Stoma patients must learn to live with this changed body and intestinal function. They must also adapt their lifestyle to these changes. It is in this direction which the stoma therapy nurse supports the patient.

The relationship between spiritual well-being and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy.

PURPOSE: We examined relationships among demographic and clinical characteristics, spiritual well-being, and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy. DESIGN: A descriptive, cross-sectional, exploratory study design was used to answer research questions. SUBJECTS AND SETTING: Participants were recruited from the outpatient ambulatory clinic in the gastrointestinal surgical department at the medical center of National Taiwan University. Forty-five Taiwanese patients aged 42 to 83 years who were diagnosed with colorectal cancer and underwent colostomy surgery participated in the study. METHODS: Participants completed a personal data questionnaire designed for this study, along with 2 validated instruments, the Spiritual Well-Being Scale and the Psychosocial Adjustment to Illness Scale-Self Report. FINDINGS: Forty-five persons participated in the study; 69% reported a moderate level of spiritual well-being. Participants reported strong adjustment to extended family relationships, but poor adjustment in sexual relationships. Spiritual well-being was significantly associated with psychosocial adjustment (r = -0.52, P < .01), and 4 predictors (income change after surgery, self-rated disease severity, time since surgery, and spiritual well-being) accounted for 53% of the variance in psychosocial adjustment. CONCLUSIONS: Spiritual well-being plays an important role for Taiwanese patients when faced with psychosocial adjustment related to life with colorectal cancer and a colostomy.

Autoimagem de clientes com colostomia em relação à bolsa coletora / Self-image of clients with colostomy related to the collecting bag / Auto-imagen de clientes con colostomía en relación con la bolsa colectora

Objetivou-se analisar a percepção do portador de colostomia em relação ao uso da bolsa coletora. Realizou-se uma pesquisa descritiva com abordagem qualitativa, no Centro Integrado de Saúde Lineu Araújo, Teresina-PI. Participaram da pesquisa dez clientes portadores de bolsa de colostomia. Os dados foram produzidos por meio de entrevistas semiestruturadas. A análise de conteúdo permitiu revelar os sentimentos, as mudanças ocorridas e como acontece o processo de adaptação da pessoa portadora da bolsa de colostomia. Constatou-se que a relação entre a pessoa portadora de colostomia e a bolsa coletora é permeada por sentimentos negativos, mudanças significativas de ordem físicas, psicológicas, sexuais, bem como na teia de suas relações sociais.

The study aimed to analyze the perception of patients with colostomy in the use of the collection bag. It was conducted a descriptive qualitative approach, on the Center for Integrated Health Lineu Araujo, Teresina-PI, Brazil. Ten clients with colostomy bag participated in the survey. Data were generated through semi-structured interviews. Content analysis has revealed the feelings, the changes and how the process of adaptation of the person with the colostomy bag occurs. It was found that the relationship between the collection bag and the person with a colostomy is filled with negative feelings, significant changes in physical, psychological and sexual order, and in the web of his/her social relationships.

El estudio objetivó analizar la percepción de los pacientes con colostomía cuanto al uso de la bolsa de recolección. Llevó-se a cabo una pesquisa con enfoque descriptivo cualitativo, en el Centro de Salud Integrado de Lineu Araujo, Teresina-PI. Participaron en la encuesta diez clientes portadores de bolsa de colostomía. Los datos fueron generados a través de entrevistas semi-estructuradas. El análisis de contenido ha puesto de manifiesto los sentimientos, los cambios y cómo funciona el proceso de adaptación de la persona con la bolsa de colostomía. Se encontró que la relación entre la la persona con una colostomía y bolsa de recolección está llena de sentimientos negativos, u de cambios significativos en los aspectos físico, psicológico y sexual; y en la red de relaciones sociales.

[Self-image of clients with colostomy related to the collecting bag]. / Autoimagem de clientes com colostomia em relação à bolsa coletora.

The study aimed to analyze the perception of patients with colostomy in the use of the collection bag. It was conducted a descriptive qualitative approach, on the Center for Integrated Health Lineu Araujo, Teresina-PI, Brazil. Ten clients with colostomy bag participated in the survey. Data were generated through semi-structured interviews. Content analysis has revealed the feelings, the changes and how the process of adaptation of the person with the colostomy bag occurs. It was found that the relationship between the collection bag and the person with a colostomy is filled with negative feelings, significant changes in physical, psychological and sexual order, and in the web of his/her social relationships.

Health-related quality of life of colorectal cancer patients receiving oral UFT plus leucovorin compared with those with surgery alone.

BACKGROUND: Adjuvant chemotherapy of oral uracil/ftorafur (UFT) plus leucovorin (LV) has been accepted as the standard of care in the treatment of patients with stage II and III carcinoma of the colon. The objective of the study was to compare HRQOL reported by patients receiving oral UFT plus LV (UFT/LV group) versus no adjuvant treatment (control group) following surgery for colorectal cancer. METHODS: Ninety nine patients in the UFT/LV group and 83 in the control group participated. HRQOL was assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 and HRQOL data measured longitudinally following surgery were compared between the groups. RESULTS: Eighty-eight percent (87 of 99) received all scheduled doses of UFT plus LV during the first three cycles, and 82 percent (81 of 99) did so for five cycles. The most common type of toxicity in the UFT/LV group was fatigue, which was generally mild. Six patients each had grade 3 diarrhea or anorexia. There were significant differences in the scores for role function, and specific limitations such as fatigue, nausea, and vomiting, dyspnoea, appetite loss, and financial difficulties, which deteriorated in the UFT/LV group. CONCLUSIONS: HRQOL in colorectal cancer patients with adjuvant chemotherapy with oral UFT plus LV deteriorated during this phase of treatment compared with those with surgery alone, despite the biased stage of tumor between the groups. Symptom management and social support would improve HRQOL in such a group of patients.

Nurses' attitudes towards the sexuality of colorectal patients.

This article reviews the literature on nurses' attitudes towards sexuality and highlights a range of studies carried out on functional outcomes following colorectal surgery. The article provides nurses with an insight into colorectal cancer, the prevalence of sexual dysfunction in men and women following colorectal surgery and the importance of addressing the various aspects of sexuality in a sensitive manner to provide patients with holistic care.

Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. OBJECTIVES: 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. SEARCH STRATEGY: A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. RESULTS: Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when functional, clinical, or QOL outcomes associated with colostomy are compared to those seen in SCI patients undergoing ileostomy. IMPLICATIONS FOR PRACTICE: 1. The WOC nurse plays a pivotal role in both conservative bowel management and the decision to undergo ostomy surgery. 2. Preoperative stoma site marking is vital for the best surgical outcome. 3. The system best suited to an individual is based on a variety of factors including but not limited to stoma location, type of effluent, peristomal plane and contours, and the individual's capabilities and preferences. 4. Some individuals with a sigmoid or descending colostomy may benefit from colostomy irrigation as a management method. 5. Postoperatively, assessment of pressure points for signs of tissue breakdown, evaluation of treatment methods for existing pressure ulcers with suitable modification, and support surface assessment should be included in ongoing annual follow-up visits.

Ostomy care and rehabilitation in colorectal cancer.

OBJECTIVES: To review ostomy care in colorectal cancer, current trends in assessment, management, and treatment, and the role of the enterostomal therapy (ET) nurse in cancer care. DATA SOURCES: Published literature and the author's clinical experiences in ostomy wound care. CONCLUSION: Care of the patient with colorectal cancer requiring an ostomy involves both physical and psychological rehabilitation. The education and skills of an ET/wound, ostomy, and continence (WOC) nurse can provide a valuable service to the patient/family, surgeon, oncology nurse, and other health care providers. IMPLICATIONS FOR ONCOLOGY NURSES: An ostomy is not a handicapping procedure. Living well with a colostomy can be achieved through proper patient preparation, education, and planning. Provision of individualized comprehensive care facilitates physical and psychological rehabilitation.

Randomized crossover comparison of adhesively coupled colostomy pouching systems.

Ostomy pouching systems affect well being and quality of life, making selection of the appropriate system a key element of ostomy care. Several innovative adhesively coupled, two-piece systems are on the market. They feature flexible low profiles, allowing pouch removal/replacement without changing the skin barrier or wafer. This facilitates inspection or pouch changes without disrupting peristomal skin. Because few controlled trials compare pouching system effectiveness, a prospective, randomized open-label, crossover study was conducted. Under the supervision of ostomy care nurses in six outpatient clinics in Germany, clinical performance of and patient preferences for two adhesively coupled, closed-end pouching systems were compared during normal use. One is a gelatin/pectin-based skin barrier sealed to the pouch with a company-specific adhesive coupling technology (System E); the other, a grooved base plate wafer adhesive pouch coupling system (System F). Seventeen attributes and seven end-of-study measures that included comfort, flexibility, wear time, ease of removal, and overall performance were assessed. Informed, consenting participants were randomly assigned to use one system for five skin barrier/wafer changes or up to 15 days and subsequently switched to the alternative system for a similar period. The 39 participants used a total of 1,645 pouches and 342 skin barriers. All were found safe as determined by incidence and nature of the reported peristomal skin problems, subject withdrawals, and adverse events for both systems. However, System E provided longer pouch wear times (P < 0.01). End-phase ratings favored System E on 10 of the 17 attributes (P < 0.04) and System Fon none. More participants preferred System E on all seven end-of-study measures, five significantly (comfort, flexibility, wear time, ease of removal, and overall performance; (P < 0.02). These participant-reported, ostomy-related outcomes underscore the importance of product evaluation and selection for persons with an ostomy.

Discharge planning in rehabilitation following surgery for a stoma.

Discharge planning and establishing goals for rehabilitation after stoma surgery is an ongoing process, which should be preceded by an holistic assessment, ideally carried out by a specialist practitioner with knowledge and experience in this area. The practitioner needs to have effective listening skills to ensure that both practical and psychological care are patient-centred. The patient and his/her carers must be involved in all aspects of care planning and establishing goals for rehabilitation. The specialist practitioner should adopt an evidence-based approach to care, ensuring that important aspects of care, such as the early teaching of stoma management skills, are not neglected. The specialist practitioner may not be able to meet all the patient's needs and should refer on to other specialist staff where these services are available. Such multidisciplinary input, utilizing appropriate problem-solving approaches with the involvement of patients and their carers, can only enhance the quality of care delivered and optimize the process of rehabilitation.

The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients.

The aim of the study was to evaluate the effects of the use of progressive muscle relaxation training (PMRT) on anxiety and quality of life in colorectal cancer patients after stoma surgery. A randomised controlled trial was used with repeated measures assessment over 10 weeks post-stoma surgery. Fifty-nine patients participated in the study and were randomised to a control group receiving routine care (n=30) and an experimental group receiving routine care and PMRT through two teaching sessions and practice at home for the first 10 weeks. The State-Trait Anxiety Inventory and two Quality of Life Scales were used to collect the data of interest in three occasions, namely during hospitalisation, at week 5 and at week 10 post-surgery. The use of PMRT significantly decreased state anxiety and improved generic quality of life in the experimental group (P<0.05), especially in the domains of physical health, psychological health, social concerns and environment. Social relationships decreased in both groups. In relation to the disease-specific quality of life measure, differences were observed only in the 10-week assessment, with the experimental group reporting better quality of life at 10 weeks, but not over time as compared to the control group. The use of PMRT should be incorporated in the long-term care of colorectal cancer patients, as it can improve their psychological health and quality of life. This may be a cost-effective intervention that needs minimal training and could easily be offered to those patients that they would like to use it as part of the specialist care provided to stoma patients.

Endoscopic transanal resection provides palliation equivalent to transabdominal resection in patients with metastatic rectal cancer.

Patients with metastatic rectal cancer precluding curative low anterior resection (LAR) or abdominoperineal resection (APR) can require palliation for impending obstruction. LAR or APR is frequently not optimal because of the associated operative morbidity. Lesser procedures such as diverting colostomy require patients to live with a permanent stoma. Endoscopic transanal resection (ETAR) has been used for excision of rectal lesions. To determine whether ETAR provides palliation equivalent to LAR or APR, we reviewed the outcomes of 49 patients with rectal adenocarcinoma and unresectable liver metastases who required palliative intervention between January 1989 and July 1996. Of these 49 patients, 24 underwent ETAR; the intraluminal tumor was resected using the urologic resectoscope to achieve a hemostatic, patent lumen. The outcomes of these patients were compared to those of the other 25 patients who had palliative LAR, APR, or a Hartmann procedure during the same period. The median distance of the tumors from the anal verge was similar (5 cm; range 1 to 15 cm). ETAR patients had a higher percentage of poorly differentiated tumors (35% vs. 6%, P = 0.034) and higher preoperative alkaline phosphatase values (478 +/- 75 mg/dl vs. 231 +/- 24 mg/dl; P < 0.015), suggesting more aggressive disease and greater hepatic tumor burden, respectively. Despite these differences, overall survival and time spent outside the hospital were similar in the two groups. The median number of debulking procedures required in the 24 ETAR patients was two (range 1 to 17). Resections in the 25 LAR/APR patients included LAR in 20, APR in two, and Hartmann procedures in three. There was a trend toward more stomas in the LAR/APR group (28% vs. 17%). More important, morbidity was significantly higher in the LAR/APR patients (24% vs. 4%; P = 0.049). In conclusion, ETAR is a safe alternative for the palliation of incurable rectal tumors. Compared to transabdominal resection, ETAR provides equivalent palliation as measured by survival and proportion of the patient's life spent outside the hospital, with a lower stoma rate and significantly less morbidity. Therefore, in select patients with metastatic rectal cancer, ETAR is an important palliative option.