Yagyu Takuki, Yamamoto Manabu, Urakami Kei, Osaki Kotaro, Yasui Chiharu, Kono Yusuke, Kihara Kyoichi, Matsunaga Tomoyuki, Tokuyasu Naruo, Sakamoto Teruhisa, Fujiwara Yoshiyuki
Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8503, Japan.
Int J Colorectal Dis. 2025 Aug 2;40(1):167. doi: 10.1007/s00384-025-04971-1.
Diverting ileostomy (DI) may cause fluid and electrolyte loss, potentially impairing the tolerability of adjuvant chemotherapy (ACT) in patients with rectal cancer. However, its clinical impact, especially in the presence of high-output stoma (HOS), remains unclear. This study aimed to evaluate the effects of DI and perioperative HOS on chemotherapy completion, dose intensity, and the incidence of severe adverse events (AEs).
We retrospectively analyzed 107 patients with rectal cancer who underwent curative resection and received postoperative ACT between June 2012 and December 2024 at Tottori University. Chemotherapy completion, relative dose intensity (RDI), and grade ≥ 3 AEs were compared between patients with and without DI. A subgroup analysis assessed the influence of HOS among DI patients.
Chemotherapy completion rate and RDI were comparable between patients with and without DI. However, the incidence of grade ≥ 3 AEs was significantly higher in the DI group than in the non-DI group (18.2% vs. 4.1%, P = 0.015), and DI was identified as an independent risk factor in multivariate analysis (odds ratio [OR] 5.749, P = 0.022). Among patients with DI, those with HOS had a significantly lower oxaliplatin RDI than those without HOS (37.5% vs. 75.0%, P = 0.007), and HOS independently predicted failure to complete oxaliplatin-based regimens (OR 13.423, P = 0.039).
While DI does not impair overall chemotherapy delivery, it is associated with increased early toxicity. HOS may compromise oxaliplatin administration and should prompt early recognition and targeted supportive interventions.
回肠转流造口术（DI）可能导致体液和电解质丢失，这可能会损害直肠癌患者辅助化疗（ACT）的耐受性。然而，其临床影响，尤其是在高输出量造口（HOS）存在的情况下，仍不清楚。本研究旨在评估DI和围手术期HOS对化疗完成情况、剂量强度以及严重不良事件（AE）发生率的影响。
我们回顾性分析了2012年6月至2024年12月在鸟取大学接受根治性切除并接受术后ACT的107例直肠癌患者。比较了有DI和无DI患者的化疗完成情况、相对剂量强度（RDI）和≥3级AE。亚组分析评估了HOS对DI患者的影响。
有DI和无DI患者的化疗完成率和RDI相当。然而，DI组≥3级AE的发生率显著高于非DI组（18.2%对4.1%，P = 0.015），并且在多变量分析中DI被确定为独立危险因素（比值比[OR] 5.749，P = 0.022）。在有DI的患者中，有HOS的患者奥沙利铂RDI显著低于无HOS的患者（37.5%对75.0%，P = 0.007），并且HOS独立预测基于奥沙利铂方案的化疗无法完成（OR 13.423，P = 0.039）。
虽然DI不会损害整体化疗的实施，但它与早期毒性增加有关。HOS可能会影响奥沙利铂的给药，应促使早期识别并进行针对性的支持性干预。
