Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1354-1362
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1354
Predictors of complications after prophylactic ileostomy reversal for rectal cancer: A retrospective study
Quan Lv, Xin-Peng Shu, Dong Peng, Si-Qi Li, Zheng Xiang
Quan Lv, Xin-Peng Shu, Dong Peng, Si-Qi Li, Zheng Xiang, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Zheng Xiang, Chongqing Key Laboratory of Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Co-first authors: Quan Lv and Xin-Peng Shu.
Author contributions: Peng D contributed to the data analysis; Lv Q and Xiang Z led the quality assessments; Lv Q and Shu XP wrote the original draft; Xiang Z and Shu XP revised the manuscript. All authors have agreed on the journal to which the manuscript will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. Both Lv Q and Shu XP have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-first authors.
Supported by Science and Technology Planning Project of Yuzhong District of Chongqing City, No. 20210115.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University.
Informed consent statement: The requirement for patients' informed consent for this study was waived due to its retrospective nature.
Conflict-of-interest statement: Academic Editor has no conflict of interest.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due but are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng Xiang, Doctor, PhD, Chief Doctor, Professor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Roud, Chongqing 400016, China. doctor13330209937@126.com
Received: January 31, 2024
Revised: April 7, 2024
Accepted: April 15, 2024
Published online: May 27, 2024
Processing time: 112 Days and 19.1 Hours
Abstract
BACKGROUND

Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately.

AIM

To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC.

METHODS

This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean ± SD and were analyzed with independent-sample t tests, while frequency variables are expressed as n (%), and the χ2 test or Fisher’s exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications.

RESULTS

The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration (P < 0.01), greater blood loss (P = 0.017), and longer operative times (P < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) (P < 0.01), preoperative comorbid hypertension (P = 0.049), time from primary surgery to ileostomy reversal (P < 0.01) and longer operation time (P = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level (P < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI (P < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal (P < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent risk factors for stoma-related complications after stoma reversal.

CONCLUSION

The preoperative albumin level was a predictor of overall complications. Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.

Keywords: Ileostomy; Reversal; Risk factors; Complications; Rectal cancer

Core Tip: There were no studies that have analyzed the risk factors for stoma-related complications and overall postoperative complications after stoma reversal for rectal cancer (RC) separately. Our study showed that the preoperative serum albumin concentration was a predictor of overall complications. Preoperative body mass index and time between initial surgery and stoma reversal were predictors of stoma-related complications. Therefore, for RC patients undergoing ileostomy reversal, adequate albumin supplementation should be provided preoperatively to reduce the incidence of postoperative complications.