General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
Updates Surg. 2023 Sep;75(6):1589-1596. doi: 10.1007/s13304-023-01614-4. Epub 2023 Aug 4.
The aim of this study was to determine the incidence of Clostridium Difficile infection (CDI) after stoma reversal in patients who underwent transanal Total Mesorectal Excision (TaTME) and to evaluate variables correlated with this post-operative infection.
Patients who underwent stoma reversal surgery following TaTME for rectal cancer between 2015 and 2023 at a high-volume Institution, were retrospectively reviewed for the post-operative occurrence of diarrhea and in-hospital CDI (positive toxin in the stools). Patients were divided into the following subgroups according to the post-operative course: Group A-no clinical symptoms; Group B-mild diarrhea (< 10 evacuations/day); Group C-severe watery diarrhea (> 10 evacuations/day) with CDI negative; and Group D-severe watery diarrhea (> 10 evacuations/day) CDI positive. Clinical and laboratory data were analyzed for their correlation with CDI. A machine learning approach was used to determine predictors of diarrhea following stoma reversal.
A total of 126 patients were selected, of whom 79 were assessed as Group A, 16 Group B, 25 Group C and 6 (4.8%) Group D. Univariable analysis documented that delayed stoma reversal correlated with CDI (Group A mean interval 44.6 weeks vs. Group D 68.4 weeks, p 0.01). The machine learning analysis confirmed the delay in stoma closure as a probability factor of presenting diarrhea; also, diarrhea probability was 80.5% in males, 77.8% in patients who underwent neoadjuvant therapy, and 63.9% in patients who underwent adjuvant therapy.
Stoma reversal surgery can result in moderate rate of in-hospital CDI. Time-to stoma reversal is a crucial variable significantly related with this adverse outcome.
本研究旨在确定接受经肛门全直肠系膜切除术（TaTME）的患者在造口还纳术后发生艰难梭菌感染（CDI）的发生率，并评估与这种术后感染相关的变量。
回顾性分析了 2015 年至 2023 年在一家高容量机构接受 TaTME 治疗直肠癌后行造口还纳术的患者的术后腹泻和院内 CDI（粪便中存在毒素阳性）的发生情况。患者根据术后病程分为以下亚组：A 组-无临床症状；B 组-轻度腹泻（每天排便<10 次）；C 组-严重水样腹泻（每天排便>10 次）但 CDI 阴性；D 组-严重水样腹泻（每天排便>10 次）且 CDI 阳性。分析临床和实验室数据与 CDI 的相关性。采用机器学习方法确定造口还纳术后腹泻的预测因素。
共纳入 126 例患者，其中 79 例评估为 A 组，16 例为 B 组，25 例为 C 组，6 例（4.8%）为 D 组。单变量分析表明，造口还纳延迟与 CDI 相关（A 组平均间隔 44.6 周，D 组 68.4 周，p=0.01）。机器学习分析证实，造口关闭延迟是出现腹泻的概率因素；此外，男性腹泻的概率为 80.5%，接受新辅助治疗的患者腹泻的概率为 77.8%，接受辅助治疗的患者腹泻的概率为 63.9%。
造口还纳术后可导致中等程度的院内 CDI。造口还纳时间是与这种不良结局显著相关的关键变量。
