Relationship between diversion colitis and quality of life in rectal cancer

Table 1 Characteristics for 30 patients with rectal cancer n (%)

Parameter	Patients
Age (yr)	59 (31-73)1
Gender
Male	21 (70.0)
Female	9 (30.0)
ASA
I	11 (36.7)
II	15 (50)
III	4 (13.3)
IV	0
Tumor location
Upper rectum	6 (20.0)
Mid rectum	5 (16.7)
Lower rectum	19 (63.3)
Intravenous chemotherapy
No	22 (73.3)
Yes	8 (26.7)
pTNM staging
0	4 (13.3)
I	6 (20.0)
II	11 (36.7)
III	7 (23.3)
IV	2 (6.7)

¹Values are median (range). ASA: American Society of Anesthesiologists; pTNM: Pathological tumor node metastasis.

Table 2 Incidence of diversion colitis n (%)

Grade of DC	1 d prior to ileostomy reversal			5-6 mo after ileostomy reversal
	Endoscopic (n = 30)	Histological (n = 30)	P value	Endoscopic (n = 30)	Histological (n = 30)	P value
None	0	0	0.084	19 (63.3)	13 (43.3)	0.195
Mild	15 (50.0)	14 (46.7)		11 (36.7)	17 (56.7)
Moderate	11 (36.7)	16 (53.3)		0	0
Severe	4 (13.3)	0		0	0

DC: Diversion colitis.

Table 3 Endoscopic and histological findings n (%)

	1 d prior to ileostomy reversal (n = 30)	5-6 mo after ileostomy reversal (n = 30)
Endoscopic finding
Edema	30 (100)	9 (30.0)
Mucosal hemorrhage	22 (73.3)	3 (10.0)
Contact bleeding	6 (20.0)	0
Histological finding
Acute inflammation	7 (23.3)	0
Chronic inflammation	30 (100)	17 (56.7)
Eosinophilic infiltration	29 (96.7)	9 (30.0)
Crypt architecture distorsion	6 (20.0)	0
Follicular lymphoid hyperplasia	12 (40.0)	0
Crypt abscess	7 (23.3)	0

Table 4 Correlation between symptoms before and after ileostomy reversal and grade of diversion colitis¹n (%)

Symptom	Endoscopic finding (n = 30)				Histological finding (n = 30)
	Mild	Moderate	Severe	P value	Mild	Moderate	Severe	P value
Symptoms before ileostomy reversal
Mucous discharge				0.073				0.284
Yes	3 (25.0)	7 (58.3)	2 (16.7)		4 (33.3)	8 (66.7)	0
No	12 (66.7)	4 (22.2)	2 (11.1)		10 (55.6)	8 (44.4)	0
Bleeding				0.338				1.000
Yes	1 (20.0)	3 (60.0)	1 (20.0)		2 (40.0)	3 (60.0)	0
No	14 (56.0)	8 (32.0)	3 (12.0)		12 (48.0)	13 (52.0)	0
Abdominal pain				0.529				0.602
Yes	1 (25.0)	2 (50.0)	1 (25.0)		1 (25.0)	3 (75.0)	0
No	14 (53.9)	9 (34.6)	3 (11.5)		13 (50.0)	13 (50.0)	0
Tenesmus				0.075				0.440
Yes	2 (22.2)	6 (66.7)	1 (11.1)		3 (33.3)	6 (66.7)	0
No	13 (61.9)	5 (23.8)	3 (14.3)		11 (52.4)	10 (47.6)	0
Symptoms after ileostomy reversal
Mucous discharge				0.679				0.336
Yes	3 (60.0)	1 (20.0)	1 (20.0)		1 (20.0)	4 (80.0)	0
No	12 (48.0)	10 (40.0)	3 (12.0)		13 (52.0)	12 (48.0)	0
Bleeding				0.550				0.228
Yes	1 (33.3)	1 (33.3)	1 (33.3)		0 (0)	3 (100)	0
No	14 (51.9)	10 (37.0)	3 (11.1)		14 (51.9)	13 (48.1)	0
Abdominal pain				0.229				0.485
Yes	1 (50.0)	0	1 (50.0)		0	2 (100)	0
No	14 (53.8)	11 (39.3)	3 (10.7)		14 (50.0)	14 (50.0)	0
Tenesmus				0.844				0.336
Yes	2 (40.0)	2 (40.0)	1 (20.0)		1 (20.0)	4 (80.0)	0
No	13 (52.0)	9 (36.0)	3 (12.0)		13 (52.0)	12 (48.0)	0
Diarrhea				0.001				0.001
Yes	0	6 (66.7)	3 (33.3)		0	9 (100)	0
No	15 (71.4)	5 (23.8)	1 (4.8)		14 (66.7)	7 (33.3)	0

¹Grade of diversion colitis means result that we examined 1 d prior to ileostomy reversal.

Table 5 Correlation between symptoms and quality of life 5 to 6 mo after ileostomy reversal n (%)

Symptom	Much worse	Slightly worse	Similar	Slightly better	Much better	P value
Mucous discharge						0.137
Yes	2 (40.0)	0	2 (40.0)	1 (20.0)	0
No	2 (8.0)	8 (32.0)	13 (52.0)	2 (8.0)	0
Bleeding						0.797
Yes	0	1 (33.3)	2 (66.7)	0	0
No	4 (14.8)	7 (25.9)	13 (48.1)	3 (11.1)	0
Abdominal pain						0.816
Yes	0	1 (50.0)	1 (50.0)	0	0
No	4 (14.3)	7 (25.0)	14 (50.0)	3 (10.7)	0
Tenesmus						0.516
Yes	1 (20.0)	2 (40.0)	1 (20.0)	1 (20.0)	0
No	3 (12.0)	6 (24.0)	14 (56.0)	2 (8.0)	0
Diarrhea						< 0.0011
Yes	4 (44.4)	5 (55.6)	0	0	0
No	0	3 (14.3)	15 (71.4)	3 (14.3)	0

¹Spearman’s correlation coefficient = -0.791.