Wang Jiwei, Lu Xiaoyun, Xu Yanan, Wu Yin, Zhang Tao, Li Jianguo
Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China.
Cancer Manag Res. 2025 Apr 15;17:801-814. doi: 10.2147/CMAR.S511962. eCollection 2025.
Postoperative adjuvant chemotherapy used in patients with stage II/III rectal cancer, is usually administered for 3 to 6 months. However, the optimal timing of protective stoma reversal remains controversial. This study aimed to investigate the effect of stoma closure before or after adjuvant chemotherapy on survival and stoma-related complications.
A retrospective analysis was conducted on 144 patients who underwent radical rectal cancer surgery, prophylactic ileostomy and adjuvant chemotherapy from June 2018 to June 2021. 104 had their stoma reversal before adjuvant chemotherapy completion (Before group) and 40 after adjuvant chemotherapy completion (After group).
There were no significant differences between the groups regarding demographics, clinical characteristics, perioperative complications, OS, or DFS. Pathologic T-stage [HR = 2.620 (1.291-5.320), = 0.008 vs HR = 2.793 (1.297-6.017), = 0.009] and N-stage [HR = 2.204 (1.168-4.157), = 0.015 vs HR = 2.068 (1.125-3.789), = 0.019] were identified as independent risk factors for OS and DFS. Stoma reversal after completing chemotherapy [OR = 39.979 (3.964-403.188), = 0.002] and comorbidity [OR = 33.395 (5.931-188.033), < 0.001] were independent risk factors for stoma-related complications. In high-risk stage III patients with T4 or N2, the 3-year OS rate was significantly lower in Before group than in After group (70.3% vs 92.6%, = 0.01), as was the 3-year DFS rate (60.94% vs 74.07%, = 0.02). Prolonged stoma duration [HR = 0.991 (0.982-1.000), = 0.048] was an OS protective factor. Stoma reversal after chemotherapy [HR = 0.370 (0.141-0.972), = 0.044] and cumulative 5-FU dosage [HR = 0.991 (0.985-0.997), = 0.003] were DFS protective factors.
In high-risk stage III patients, delayed stoma reversal after adjuvant chemotherapy may improve survival, but it may also lead to more stoma-related complications.
II/III期直肠癌患者术后辅助化疗通常持续3至6个月。然而，保护性造口回纳的最佳时机仍存在争议。本研究旨在探讨辅助化疗前或后进行造口关闭对生存及造口相关并发症的影响。
对2018年6月至2021年6月期间接受直肠癌根治术、预防性回肠造口术及辅助化疗的144例患者进行回顾性分析。104例在辅助化疗完成前进行造口回纳（术前组），40例在辅助化疗完成后进行造口回纳（术后组）。
两组在人口统计学、临床特征、围手术期并发症、总生存期（OS）或无病生存期（DFS）方面无显著差异。病理T分期[风险比（HR）=2.620（1.291 - 5.320），P = 0.008；对比HR = 2.793（1.297 - 6.017），P = 0.009]和N分期[HR = 2.204（1.168 - 4.157），P = 0.015；对比HR = 2.068（1.125 - 3.789），P = 0.019]被确定为OS和DFS的独立危险因素。化疗完成后进行造口回纳[比值比（OR）=39.979（3.964 - 403.188），P = 0.002]和合并症[OR = 33.395（5.931 - 188.033），P < 0.001]是造口相关并发症的独立危险因素。在T4或N2的高危III期患者中，术前组的3年OS率显著低于术后组（70.3%对92.6%，P = 0.01），3年DFS率也是如此（60.94%对74.07%，P = 0.02）。造口持续时间延长[HR = 0.991（0.982 - 1.000），P = 0.048]是OS的保护因素。化疗后进行造口回纳[HR = 0.370（0.141 - 0.972），P = 0.044]和5-氟尿嘧啶累积剂量[HR = 0.991（0.985 - 0.997），P = 0.003]是DFS的保护因素。
在高危III期患者中，辅助化疗后延迟造口回纳可能改善生存，但也可能导致更多造口相关并发症。
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