Clinical impact of diverting ileostomy and high-output stoma on adjuvant chemotherapy for rectal cancer: a retrospective cohort study.

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2025-08-02 DOI:10.1007/s00384-025-04971-1

Takuki Yagyu, Manabu Yamamoto, Kei Urakami, Kotaro Osaki, Chiharu Yasui, Yusuke Kono, Kyoichi Kihara, Tomoyuki Matsunaga, Naruo Tokuyasu, Teruhisa Sakamoto, Yoshiyuki Fujiwara

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引用次数: 0

Abstract

Purpose: Diverting ileostomy (DI) may cause fluid and electrolyte loss, potentially impairing the tolerability of adjuvant chemotherapy (ACT) in patients with rectal cancer. However, its clinical impact, especially in the presence of high-output stoma (HOS), remains unclear. This study aimed to evaluate the effects of DI and perioperative HOS on chemotherapy completion, dose intensity, and the incidence of severe adverse events (AEs).

Methods: We retrospectively analyzed 107 patients with rectal cancer who underwent curative resection and received postoperative ACT between June 2012 and December 2024 at Tottori University. Chemotherapy completion, relative dose intensity (RDI), and grade ≥ 3 AEs were compared between patients with and without DI. A subgroup analysis assessed the influence of HOS among DI patients.

Results: Chemotherapy completion rate and RDI were comparable between patients with and without DI. However, the incidence of grade ≥ 3 AEs was significantly higher in the DI group than in the non-DI group (18.2% vs. 4.1%, P = 0.015), and DI was identified as an independent risk factor in multivariate analysis (odds ratio [OR] 5.749, P = 0.022). Among patients with DI, those with HOS had a significantly lower oxaliplatin RDI than those without HOS (37.5% vs. 75.0%, P = 0.007), and HOS independently predicted failure to complete oxaliplatin-based regimens (OR 13.423, P = 0.039).

Conclusions: While DI does not impair overall chemotherapy delivery, it is associated with increased early toxicity. HOS may compromise oxaliplatin administration and should prompt early recognition and targeted supportive interventions.

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回肠分流造口和高输出量造口对直肠癌辅助化疗的临床影响：回顾性队列研究。

目的：转移回肠造口术（DI）可能导致液体和电解质流失，潜在地损害直肠癌患者对辅助化疗（ACT）的耐受性。然而，其临床影响，特别是在存在高输出口（HOS）的情况下，仍不清楚。本研究旨在评估DI和围手术期HOS对化疗完成度、剂量强度和严重不良事件（ae）发生率的影响。方法：回顾性分析2012年6月至2024年12月鸟取大学107例接受根治性切除并术后行ACT治疗的直肠癌患者。比较有无DI患者的化疗完成度、相对剂量强度（RDI）和≥3级ae。亚组分析评估了HOS对DI患者的影响。结果：化疗完成率和RDI在有和没有DI的患者之间具有可比性。然而，DI组≥3级ae的发生率明显高于非DI组（18.2% vs. 4.1%, P = 0.015）， DI在多因素分析中被确定为独立危险因素（优势比[OR] 5.749, P = 0.022）。在DI患者中，HOS患者的奥沙利铂RDI显著低于无HOS患者（37.5% vs. 75.0%, P = 0.007）， HOS独立预测无法完成奥沙利铂治疗方案（OR 13.423, P = 0.039）。结论：虽然DI不影响化疗的整体传递，但它与早期毒性增加有关。居屋计划可能影响奥沙利铂的使用，因此应及早发现并采取有针对性的支持性干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.