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Impact of ileostomy in the adjuvant treatment and outcome of colon cancer

Background After tumor resection, a preventive diverting loop ileostomy creation is a routine surgical procedure to prevent anastomotic leakage and infections and to preclude secondary surgeries. Despite its benefits, several studies have proposed potential complications that extend the disease cour...

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Published in:International journal of colorectal disease 2023-06, Vol.38 (1), p.158-158, Article 158
Main Authors: Calderillo-Ruíz, Germán, López-Basave, Horacio Noé, Muñoz-Montaño, Wendy Rossemary, Díaz-Romero, María Consuelo, Carbajal-López, Berenice, Castillo-Morales, Carolina, Pérez-Yépez, Eloy Andrés, Albarran-García, Alejandra
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container_title International journal of colorectal disease
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creator Calderillo-Ruíz, Germán
López-Basave, Horacio Noé
Muñoz-Montaño, Wendy Rossemary
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Carbajal-López, Berenice
Castillo-Morales, Carolina
Pérez-Yépez, Eloy Andrés
Albarran-García, Alejandra
description Background After tumor resection, a preventive diverting loop ileostomy creation is a routine surgical procedure to prevent anastomotic leakage and infections and to preclude secondary surgeries. Despite its benefits, several studies have proposed potential complications that extend the disease course by impairing the feasibility of adjuvant chemotherapy and adherence. Purpose The aim of this study was to evaluate the impact of ileostomy complications on the adherence to adjuvant treatment and overall survival (OS) of colon cancer (CC) patients. Methods Retrospective, observational study. Patients diagnosed with colon adenocarcinoma were treated between January 2010 and December 2020 at the National Cancer Institute in Mexico. Statistical analysis χ 2 and t -test, Kaplan–Meier, log-rank, and Cox regression. Statistical significance differences were assessed when p was bilaterally 
doi_str_mv 10.1007/s00384-023-04421-w
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Despite its benefits, several studies have proposed potential complications that extend the disease course by impairing the feasibility of adjuvant chemotherapy and adherence. Purpose The aim of this study was to evaluate the impact of ileostomy complications on the adherence to adjuvant treatment and overall survival (OS) of colon cancer (CC) patients. Methods Retrospective, observational study. Patients diagnosed with colon adenocarcinoma were treated between January 2010 and December 2020 at the National Cancer Institute in Mexico. Statistical analysis χ 2 and t -test, Kaplan–Meier, log-rank, and Cox regression. Statistical significance differences were assessed when p was bilaterally &lt; 0.05. Results The most frequent complications of loop-derived ileostomy were hydro-electrolytic dehydration (50%), acute kidney injury (AKI) (26%), grade 1–2 diarrhea (28%), and grade 3–4 diarrhea (21%) ( p  = 0.001). Patients with complete chemotherapy did not reach the median OS. In contrast, the median OS for patients with non-complete chemotherapy was 56 months ( p  = 0.023). Additionally, 5-year OS reached to 100% in the early restitution group, 85% in the late restitution group, and 60% in the non-restitution group ( p  = 0.016). Finally, AKI ( p  = 0.029; 95% confidence interval (CI) 3.348 [1.133–9.895]), complete chemotherapy ( p  = 0.028; 95% CI 0.376 [0.105–0.940]), and reversed ileostomy ( p  = 0.001; 95% CI 0.125 [0.038–0.407]) remained as predictors of overall survival for patients with CC treated with a loop ileostomy. Conclusions Our results emphasize the early stoma reversal restitution as a safe and feasible alternative to prevent severe complications related to ileostomies which improve chemotherapy adherence and overall survival of colon cancer patients. This is one of the pioneer studies analyzing the impact of ileostomy on treatment adherence and outcome of Latin American patients with colon cancer. 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Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>COPYRIGHT 2023 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c524t-7f04b84c9e639e166adb7bda8d4110dd039c88dbb839b0adb15a0cc0a4c385f13</citedby><cites>FETCH-LOGICAL-c524t-7f04b84c9e639e166adb7bda8d4110dd039c88dbb839b0adb15a0cc0a4c385f13</cites><orcidid>0000-0001-7929-0175</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37261538$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calderillo-Ruíz, Germán</creatorcontrib><creatorcontrib>López-Basave, Horacio Noé</creatorcontrib><creatorcontrib>Muñoz-Montaño, Wendy Rossemary</creatorcontrib><creatorcontrib>Díaz-Romero, María Consuelo</creatorcontrib><creatorcontrib>Carbajal-López, Berenice</creatorcontrib><creatorcontrib>Castillo-Morales, Carolina</creatorcontrib><creatorcontrib>Pérez-Yépez, Eloy Andrés</creatorcontrib><creatorcontrib>Albarran-García, Alejandra</creatorcontrib><title>Impact of ileostomy in the adjuvant treatment and outcome of colon cancer</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Background After tumor resection, a preventive diverting loop ileostomy creation is a routine surgical procedure to prevent anastomotic leakage and infections and to preclude secondary surgeries. Despite its benefits, several studies have proposed potential complications that extend the disease course by impairing the feasibility of adjuvant chemotherapy and adherence. Purpose The aim of this study was to evaluate the impact of ileostomy complications on the adherence to adjuvant treatment and overall survival (OS) of colon cancer (CC) patients. Methods Retrospective, observational study. Patients diagnosed with colon adenocarcinoma were treated between January 2010 and December 2020 at the National Cancer Institute in Mexico. Statistical analysis χ 2 and t -test, Kaplan–Meier, log-rank, and Cox regression. Statistical significance differences were assessed when p was bilaterally &lt; 0.05. Results The most frequent complications of loop-derived ileostomy were hydro-electrolytic dehydration (50%), acute kidney injury (AKI) (26%), grade 1–2 diarrhea (28%), and grade 3–4 diarrhea (21%) ( p  = 0.001). Patients with complete chemotherapy did not reach the median OS. In contrast, the median OS for patients with non-complete chemotherapy was 56 months ( p  = 0.023). Additionally, 5-year OS reached to 100% in the early restitution group, 85% in the late restitution group, and 60% in the non-restitution group ( p  = 0.016). Finally, AKI ( p  = 0.029; 95% confidence interval (CI) 3.348 [1.133–9.895]), complete chemotherapy ( p  = 0.028; 95% CI 0.376 [0.105–0.940]), and reversed ileostomy ( p  = 0.001; 95% CI 0.125 [0.038–0.407]) remained as predictors of overall survival for patients with CC treated with a loop ileostomy. Conclusions Our results emphasize the early stoma reversal restitution as a safe and feasible alternative to prevent severe complications related to ileostomies which improve chemotherapy adherence and overall survival of colon cancer patients. This is one of the pioneer studies analyzing the impact of ileostomy on treatment adherence and outcome of Latin American patients with colon cancer. 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Despite its benefits, several studies have proposed potential complications that extend the disease course by impairing the feasibility of adjuvant chemotherapy and adherence. Purpose The aim of this study was to evaluate the impact of ileostomy complications on the adherence to adjuvant treatment and overall survival (OS) of colon cancer (CC) patients. Methods Retrospective, observational study. Patients diagnosed with colon adenocarcinoma were treated between January 2010 and December 2020 at the National Cancer Institute in Mexico. Statistical analysis χ 2 and t -test, Kaplan–Meier, log-rank, and Cox regression. Statistical significance differences were assessed when p was bilaterally &lt; 0.05. Results The most frequent complications of loop-derived ileostomy were hydro-electrolytic dehydration (50%), acute kidney injury (AKI) (26%), grade 1–2 diarrhea (28%), and grade 3–4 diarrhea (21%) ( p  = 0.001). Patients with complete chemotherapy did not reach the median OS. 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subjects Adjuvant treatment
Analysis
Cancer
Care and treatment
Colon cancer
Complications and side effects
Diarrhea
Gastroenterology
Hepatology
Infection
Internal Medicine
Medicine
Medicine & Public Health
Oncology, Experimental
Patient compliance
Proctology
Surgery
Type 2 diabetes
title Impact of ileostomy in the adjuvant treatment and outcome of colon cancer
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