Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Tech Coloproctol. 2023 Dec;27(12):1227-1234. doi: 10.1007/s10151-023-02790-6. Epub 2023 Mar 27.
In patients with chemotherapy, there is no consensus on the timing of ileostomy closure. Ileostomy reversal could improve the quality of life and minimise the long-term adverse events of delayed closure. In this study, we evaluated the impact of chemotherapy on ileostomy closure and searched for the predictive factors for complications.
We retrospectively analysed 212 patients with rectal cancer who underwent ileostomy closure surgery during and without chemotherapy and were consecutively enrolled between 2010 and 2016. As a result of the heterogeneity of the two groups, propensity score matching (PSM) was performed with a 1:1 PSM cohort.
A total of 162 patients were included in the analysis. The overall stoma closure-related complications (12.4% vs. 11.1%, p = 1.00) and major complications (2.5% vs. 6.2%, p = 0.44) were not significantly different between the two groups. Multivariate analysis demonstrated that chronic kidney disease and bevacizumab use are risk factors for major complications.
Patients with oral or intravenous chemotherapy can safely have ileostomy closure with an adequate time delay from chemotherapy. When patients use bevacizumab, major complications related to ileostomy closure should still be cautioned.
在接受化疗的患者中，对于回肠造口关闭的时机尚无共识。回肠造口逆转可以提高生活质量，并最大限度减少延迟关闭的长期不良事件。本研究评估了化疗对回肠造口关闭的影响，并寻找并发症的预测因素。
我们回顾性分析了 2010 年至 2016 年间连续收治的 212 例接受回肠造口关闭手术的直肠癌患者，其中化疗期间和无化疗期间各 106 例。由于两组之间存在异质性，采用了 1:1 的倾向评分匹配（PSM）队列。
共纳入 162 例患者进行分析。两组患者的总吻合口相关并发症（12.4% vs. 11.1%，p=1.00）和主要并发症（2.5% vs. 6.2%，p=0.44）差异均无统计学意义。多因素分析表明，慢性肾脏病和贝伐珠单抗的使用是发生主要并发症的危险因素。
接受口服或静脉化疗的患者可以安全地进行回肠造口关闭，与化疗有足够的时间延迟。当患者使用贝伐珠单抗时，仍应警惕与回肠造口关闭相关的主要并发症。
