Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France.
Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France.
Anticancer Res. 2024 Nov;44(11):4995-5005. doi: 10.21873/anticanres.17324.
BACKGROUND/AIM: During low anterior rectal resection for rectal cancer, a protective ileostomy (PI) is routinely created to reduce the severity of anastomotic complications. The aim of this study was to investigate the side-effects of PI during adjuvant chemotherapy.
A retrospective cohort of patients was operated on for non-metastatic rectal cancer with a PI during 2005-2022. Patients treated with adjuvant chemotherapy (AC) were compared with those not receiving AC. A subgroup analysis compared patients with early PI closure (<10 weeks) and those with a PI in place during chemotherapy.
A total of 242 patients were included: 178 (73.6%) without adjuvant chemotherapy and 64 (26.4%) with. History, tumour location, neoadjuvant treatment and postoperative follow-up were similar for both groups. Patients treated with AC had a greater risk of renal failure (37.5% vs. 14.6%, p=0.0002), ionic disorders (45.3% vs. 26.9% p=0.008), malnutrition (23.4% vs. 5.6%, p=0.0002) and rehospitalization (35.9% vs. 18.5% p=0.007). Patients treated with AC needed significant dose adjustments of oxaliplatin in 40.6% of cases, this adjustment being higher in patients with a PI compared to patients with early closure (47.1 vs. 9.1%, p=0.021).
Presence of a PI during chemotherapy predisposes to increased episodes of renal failure, and requires major adaptation of chemotherapy doses, especially of oxaliplatin.
背景/目的：在直肠癌前侧低位直肠切除术时，为了降低吻合口并发症的严重程度，常规行保护性回肠造口术（PI）。本研究旨在探讨 PI 在辅助化疗期间的副作用。
回顾性分析了 2005 年至 2022 年间行非转移性直肠癌手术且行 PI 的患者。比较了接受辅助化疗（AC）和未接受 AC 治疗的患者。亚组分析比较了早期 PI 关闭（<10 周）和化疗期间保留 PI 的患者。
共纳入 242 例患者：178 例（73.6%）未接受辅助化疗，64 例（26.4%）接受化疗。两组患者的病史、肿瘤位置、新辅助治疗和术后随访相似。接受 AC 治疗的患者发生肾功能衰竭的风险更高（37.5%比 14.6%，p=0.0002）、离子紊乱（45.3%比 26.9%，p=0.008）、营养不良（23.4%比 5.6%，p=0.0002）和再住院率（35.9%比 18.5%，p=0.007）更高。接受 AC 治疗的患者中有 40.6%需要调整奥沙利铂的剂量，而 PI 组调整的比例高于早期关闭组（47.1%比 9.1%，p=0.021）。
化疗期间存在 PI 会增加肾功能衰竭的发作次数，并需要对化疗剂量进行重大调整，尤其是奥沙利铂的剂量。
