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. 2025 May 14;23(1):185.
doi: 10.1186/s12957-025-03843-w.

Machine learning prediction model of prolonged delay to loop ileostomy closure after rectal cancer surgery: a retrospective study

Jianying Liu  1 , Mengxiao Jiang  2 , Xiaoping Chen  2 , Yonglan Ge  1 , Zongxin Zheng  2 , Xia Yang  1 , Wenhao Zhou  1 , Huiting Zhang  3 , Meichun Zheng  4 , Baojia Luo  5
Affiliations

Machine learning prediction model of prolonged delay to loop ileostomy closure after rectal cancer surgery: a retrospective study

Jianying Liu et al. World J Surg Oncol. .

Abstract

Background: Delayed closure of a temporary ileostomy in patients with rectal cancer may cause psychological, physiological, and socioeconomic burdens to patients.

Purpose: This study aimed to develop and validate a machine learning-based model to predict the delayed ileostomy closure after surgery in patients with rectal cancer.

Design: A retrospective study.

Methods: LASSO regression was used for feature screening, and XGBoost was used for machine learning model construction. Model performance was assessed by receiver operating characteristic (ROC) curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score. The SHAP method was used to interpretate the results of the machine learning model.

Results: A total of 442 rectal cancer patients who received a loop ileostomy were included in this study, and 305 experienced delayed closure (69%). The XGBoost model area under the ROC curve (AUC) of the training set was 0.744 (95% confidence interval [CI]: 0.686-0.806) and of the test set was 0.809 (95% CI: 0.728-0.889). The importance of each variable, in descending order was body mass index (BMI), postoperative chemotherapy, distance from tumor to anal margin, depth of tumor infiltration, neoadjuvant chemoradiotherapy, and anastomotic stenosis. The importance of SHAP variables in the model from high to low was: 'BMI' 'postoperative chemotherapy' 'distance of the tumor from the anal verge' 'depth of tumor infiltration' 'neoadjuvant radiotherapy' 'anastomotic stenosis'.

Conclusion: The XGBoost machine learning model we constructed showed good performance in predicting delayed closure of loop ileostomy in rectal cancer patients. In addition, the SHAP method can help better understand the results of machine learning models.

Keywords: Delayed closure; Loop ileostomy; Machine learning; Rectal cancer.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Review Committee of Sun Yat-sen University Cancer Center (SL-B2024-578-01). Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that might influence the work reported in this paper. Sources of funding: This study has not attained any funding.

Figures

Fig. 1
Fig. 1
LASSO coefficient path diagram
Fig. 2
Fig. 2
LASSO regularization path diagram, where the model has fewer features. while maintaining predictive performance when the regularization parameter value is set to one standard deviation
Fig. 3
Fig. 3
Receiver operating characteristic curve of the model on the training set(A). Receiver operating characteristic curve of the model validation set(B)
Fig. 4
Fig. 4
Calibration curve of the model training set(A). Calibration curve of the model validation set (B)
Fig. 5
Fig. 5
Clinical decision curve of the model on the training set(A). Clinical decision curve of the model validation set(B)
Fig. 6
Fig. 6
Importance chart for SHAP variables
Fig. 7
Fig. 7
SHAP force plot for “true positive” (A). SHAP force plot for “true negative” (B)
See this image and copyright information in PMC

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