Evidence map›Paper›PMID 40121358›Full record

ArticleUpdates in surgery2025

Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey.

Andrea Balla, Federica Saraceno, Marika Rullo, Salvador Morales-Conde, Eduardo M Targarona Soler, Salomone Di Saverio, Mario Guerrieri, Pasquale Lepiane, Nicola Di Lorenzo, Michel Adamina and 41 more

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Article in Updates in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

51 authors.

Andrea BallaDepartment of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Seville, Spain. andrea.balla@gmail.com.ORCID http://orcid.org/0000-0002-0182-8761
Federica SaracenoUOSD Chirurgia d'Urgenza, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
Marika RulloSocial Psychology, Department of Education, Humanities and Intercultural Communication, University of Siena, Siena, Italy.
Salvador Morales-CondeDepartment of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Seville, Spain.ORCID http://orcid.org/0000-0003-2833-0717
Eduardo M Targarona SolerGeneral and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
Salomone Di SaverioASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy.
Mario GuerrieriDepartment of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121, Ancona, Italy.
Pasquale LepianeUOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy.
Nicola Di LorenzoDepartment of Surgery Pietro Valdoni Institute, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Michel AdaminaDepartment of Surgery, Cantonal Hospital of Fribourg and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
Isaias AlarcónUnit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Seville, Spain.
Alberto ArezzoDepartment of Surgical Sciences, University of Torino, Turin, Italy.
Jesus Bollo RodriguezGeneral and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
Luigi BoniDepartment of General & Minimally Invasive Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico di Milano, Milan, Italy.
Sebastiano BiondoBellvitge University Hospital, Barcelona, Spain.
Francesco Maria CarranoProgram in Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", 00133, Rome, Italy.
Manish ChandDivision of Surgery and Interventional Sciences, University College London, London, UK.
John T JenkinsDepartment of Colorectal Surgery, St Mark's Hospital, North West London NHS Trust, London, UK.
Justin DaviesCambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.
Salvadora Delgado RivillaHead of General Surgery at Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain.
Paolo DelrioColorectal Surgical Oncology, Istituto Nazionale Dei Tumori, IRCCS Fondazione Pascale, Naples, Italy.
Ugo ElmoreDepartment of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, 20132, Milan, Italy.
Eloy Espin-BasanyChief of Colorectal Surgery Unit, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Alessandro FicheraSection of Colon and Rectal Surgery, Center for Advanced Digestive Care, Weill Cornell Medicine, New York, USA.
Blas Flor LorenteDigestive Surgery Department, "La Fe" University Hospital, Valencia, Spain.
Nader FrancisDepartment of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK.
Marcos Gómez RuizColorectal Surgery Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.ORCID http://orcid.org/0000-0002-0848-4682
Dieter HahnloserUniversity Hospital Lausanne, Lausanne, Switzerland.
Eugenio LicardieDepartment of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Seville, Spain.ORCID http://orcid.org/0000-0001-5622-9793
Carmen MartinezGeneral and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
Monica OrtenziDepartment of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121, Ancona, Italy.
Yves PanisDepartment of Colorectal Surgery, Groupe Hospitalier Privé Ambroise-Paré Hartmann, Neuilly, France.
Carlos Pastor IdoateDepartment of General Surgery, Division of Colorectal Surgery, University Clinic of Navarre, Madrid, Spain.
Alessandro M PaganiniDepartment of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Miguel PeraDepartment of General and Digestive Surgery, Hospital Clínic Barcelona, Barcelona, Spain.
Roberto PerinottiGeneral Surgery, SS Colo-Rectal and Proctological Surgery, Biella Hospital, Ponderano, Biella, Italy.
Daniel A PopowichSt. Francis Hospital, Roslyn, NY, USA.
Timothy RockallGeneral Surgery at Royal Surrey NHS Foundation Trust, Guildford, UK.
Riccardo RosatiDepartment of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, 20132, Milan, Italy.
Alberto SartoriDepartment of General and Emergency Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy.
Daniele ScoglioDepartment of General Surgery, AULSS 4 Veneto Orientale, San Donà di Piave General Hospital, San Donà di Piave, Italy.
Mostafa ShalabyColorectal Surgery Unit, Department of General Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt.ORCID http://orcid.org/0000-0002-0358-2398
Vicente Simó FernándezHead of Colorectal Unit, Coloproctology Unit, Río Hortega Hospital, Valladolid, Spain.
Neil J SmartExeter Hospital, Exeter, UK.ORCID http://orcid.org/0000-0002-3043-8324
Antonino SpinelliDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
Patricia SyllaMount Sinai Hospital, New York, NY, USA.
Pieter J TanisDepartment of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands.
Javier Valdes HernandezColorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Seville, Spain.ORCID http://orcid.org/0000-0002-0837-8986
Steven D WexnerEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Pierpaolo SileriColorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
Protective Ileostomy Creation after Anterior Resection of the Rectum (PICARR) Collaborative Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

In our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p =  < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI "tailored" to patients' risk factors (p =  < 0.0001) and "influenced by my experience" in case of patients with low/moderate risk of anastomotic leakage (p =  < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice.

Indexed as

Clinical Decision-MakingDecision MakingIleostomyPractice Patterns, Physicians'Rectal NeoplasmsRectumAnastomosis, SurgicalFemaleHumansMaleMiddle AgedSurveys and QuestionnairesAdenocarcinomaAnterior resection of the rectumDecision-making processDefunctioning stomaProtective ileostomy

Identifiers

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.