Impact of Ileostomy in the Adjuvant Treatment and Outcome of Colon Cancer

Abstract

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. Retrospectively Registered: No. 2021/045, in April 2021. Statistical analysis: X2 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-years 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 pioneers’ 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.