Fujino Shiki, Miyoshi Norikatsu, Ohue Masayuki, Takahashi Yuske, Yasui Masayoshi, Sugimura Keijiro, Akita Hirohumi, Takahashi Hidenori, Kobayashi Shogo, Yano Masahiko, Sakon Masato
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Mol Clin Oncol. 2017 Sep;7(3):468-472. doi: 10.3892/mco.2017.1336. Epub 2017 Jul 19.
The aim of the present study was to examine the risk factors of high-output ileostomy (HOI), which is associated with electrolyte abnormalities and/or stoma complications, and to create a prediction model. The medical records of 68 patients who underwent colorectal cancer surgery with ileostomy between 2011 and 2016 were retrospectively investigated. All the patients underwent surgical resection for colorectal cancer at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan). A total of 7 patients with inadequate data on ileostomy output were excluded. Using a group of 50 patients who underwent surgery between 2011 and 2013, the risk of HOI was classified by a decision tree model using a partition platform. The HOI prediction model was validated in an additional group of 11 patients who underwent surgery between 2014 and 2016. Univariate analysis of clinical factors demonstrated that young age (P=0.003) and high white blood cell (WBC) count (P<0.001) after surgery were significantly correlated with HOI. Operative factors, such as surgical procedure, approach, operative time and blood loss, were not significantly correlated with HOI. Using these clinical factors, the risk of HOI was classified by statistical partition. In this model, three factors (gender, age and WBC on postoperative day 1) were generated for the prediction of HOI. The patients were classified into five groups, and HOI was observed in 0-88% of patients in each group. The area under the curve (AUC) was 0.838. The model was validated by an external dataset in an independent patient group, for which the AUC was 0.792. In conclusion, HOI patients were classified and an HOI prediction model was developed that may help clinicians in postoperative care.
本研究的目的是探究高输出量回肠造口术（HOI）的风险因素（其与电解质异常和/或造口并发症相关）并创建一个预测模型。对2011年至2016年间接受结直肠癌手术并行回肠造口术的68例患者的病历进行了回顾性研究。所有患者均在大阪癌症与心血管疾病医学中心（日本大阪）接受了结直肠癌手术切除。共有7例回肠造口术输出数据不足的患者被排除。利用一组在2011年至2013年间接受手术的50例患者，采用分区平台通过决策树模型对HOI风险进行分类。HOI预测模型在另外一组于2014年至2016年间接受手术的11例患者中得到验证。临床因素的单因素分析表明，年轻（P = 0.003）以及术后高白细胞（WBC）计数（P < 0.001）与HOI显著相关。手术因素，如手术方式、入路、手术时间和失血量，与HOI无显著相关性。利用这些临床因素，通过统计分区对HOI风险进行分类。在该模型中，生成了三个因素（性别、年龄和术后第1天的WBC）用于预测HOI。患者被分为五组，每组中HOI的观察发生率为0 - 88%。曲线下面积（AUC）为0.838。该模型在一个独立患者组的外部数据集中得到验证，其AUC为0.792。总之，对HOI患者进行了分类，并开发了一个HOI预测模型，这可能有助于临床医生进行术后护理。
