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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

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

χ2 and t-test, Kaplan–Meier, log-rank, and Cox regression. Statistical significance differences were assessed when p was bilaterally < 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.

Trial registration

Retrospective study No. 2021/045, in April 2021.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

This study and the research behind it would not have been possible without the exceptional support and contributions of all the authors included.

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Authors and Affiliations

  1. Oncología Médica, Unidad Funcional de Gastroenterología, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Sección XVI, 14080, Tlalpan, Mexico City, Mexico

    Germán Calderillo-Ruíz, Horacio Noé López-Basave, Wendy Rossemary Muñoz-Montaño & Berenice Carbajal-López

  2. Cátedra-CONACYT, Dirección de Cátedras (CONACYT), Mexico, Laboratorio de Genómica, Instituto Nacional de Cancerología, Mexico City, Mexico

    María Consuelo Díaz-Romero

  3. Investigación Clínica, Unidad Funcional de Gastroenterología, Instituto Nacional de Cancerología, Mexico City, Mexico

    Carolina Castillo-Morales, Eloy Andrés Pérez-Yépez & Alejandra Albarran-García

Authors
  1. Germán Calderillo-Ruíz
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  2. Horacio Noé López-Basave
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  3. Wendy Rossemary Muñoz-Montaño
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  4. María Consuelo Díaz-Romero
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  5. Berenice Carbajal-López
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  6. Carolina Castillo-Morales
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  7. Eloy Andrés Pérez-Yépez
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  8. Alejandra Albarran-García
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Germán Calderillo-Ruíz, Horacio Noé López-Basave, Rossemary Muñoz-Montaño, María Consuelo Díaz-Romero, and Alejandra Albarran-García. The first draft of the manuscript was written by Germán Calderillo-Ruíz, Berenice Carbajal-López, Eloy Andrés Pérez-Yépez, and Carolina Castillo-Morales and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Germán Calderillo-Ruíz.

Ethics declarations

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics and Clinical Research Committee of the National Cancer Institute has approved this study (Approval Number: 2021/045).

Consent to participate

This is a retrospective observational study. The Ethics and Clinical Research Committee of the National Cancer Institute has confirmed that no consent to participate was needed.

Consent for publication

This is a retrospective observational study. The Ethics and Clinical Research Committee of the National Cancer Institute has confirmed that no consent to publish was needed.

Conflict of interest

The authors declare no competing interests.

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Calderillo-Ruíz, G., López-Basave, H.N., Muñoz-Montaño, W.R. et al. Impact of ileostomy in the adjuvant treatment and outcome of colon cancer. Int J Colorectal Dis 38, 158 (2023). https://doi.org/10.1007/s00384-023-04421-w

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  • DOI: https://doi.org/10.1007/s00384-023-04421-w

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