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. 2025 Aug 2;40(1):167.
doi: 10.1007/s00384-025-04971-1.

Clinical impact of diverting ileostomy and high-output stoma on adjuvant chemotherapy for rectal cancer: a retrospective cohort study

Takuki Yagyu  1 , Manabu Yamamoto  2 , Kei Urakami  2 , Kotaro Osaki  2 , Chiharu Yasui  2 , Yusuke Kono  2 , Kyoichi Kihara  2 , Tomoyuki Matsunaga  2 , Naruo Tokuyasu  2 , Teruhisa Sakamoto  2 , Yoshiyuki Fujiwara  2
Affiliations

Clinical impact of diverting ileostomy and high-output stoma on adjuvant chemotherapy for rectal cancer: a retrospective cohort study

Takuki Yagyu et al. Int J Colorectal Dis. .

Abstract

Purpose: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Adjuvant chemotherapy; Diverting ileostomy; High-output stoma; Rectal cancer.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. The present study was approved by the Certified Review Board of Tottori University Hospital (approval number: 21A075). Ethics approval and consent to participate: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review board of ethics committee and national research committee with the 1964 Helsinki declaration and its later amendments. Disclosure: Authors declare no Conflict of Interests for this article. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient flowchart. Of the 504 patients who underwent curative rectal cancer surgery, 107 who received adjuvant chemotherapy were included in this study. Patients were divided on the basis of the presence or absence of a diverting ileostomy, and subgroup analysis was performed on the basis of the presence of a high-output stoma. ACT, adjuvant chemotherapy; DI, diverting ileostomy; HOS, high-output stoma
Fig. 2
Fig. 2
Kaplan–Meier curves for the incidences of adverse events. (a) Cumulative incidence of grade ≥ 2 adverse events during adjuvant chemotherapy. (b) Cumulative incidence of grade ≥ 3 adverse events during adjuvant chemotherapy. ACT, adjuvant chemotherapy; DI, diverting ileostomy; AEs, adverse events
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References

    1. Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229–263. 10.3322/caac.21834 - PubMed
    1. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB (2019) Colorectal cancer. Lancet 394:1467–1480. 10.1016/s0140-6736(19)32319-0 - PubMed
    1. Benson AB, Venook AP, Adam M et al (2024) NCCN guidelines® insights: rectal cancer, version 3.2024. J Natl Compr Canc Netw 22:366–375. 10.6004/jnccn.2024.0041 - PubMed
    1. Kuebler JP, Wieand HS, O’Connell MJ et al (2007) Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol 25:2198–2204. 10.1200/jco.2006.08.2974 - PubMed
    1. André T, Boni C, Navarro M et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27:3109–3116. 10.1200/jco.2008.20.6771 - PubMed

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