Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Abstract

Abstract. The aim of the present study was to examine the risk factors of high-output ileostomy (HOI), which is associated with electrolyte abnormalities and/or stoma complications, and to create a prediction model. The medical records of 68 patients who underwent colorectal cancer surgery with ileostomy between 2011 and 2016 were retrospectively investigated. All the patients underwent surgical resection for colorectal cancer at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan). A total of 7 patients with inadequate data on ileostomy output were excluded. Using a group of 50 patients who underwent surgery between 2011 and 2013, the risk of HOI was classified by a decision tree model using a partition platform. The HOI prediction model was validated in an additional group of 11 patients who underwent surgery between 2014 and 2016. Univariate analysis of clinical factors demonstrated that young age (P=0.003) and high white blood cell (WBC) count (P<0.001) after surgery were significantly correlated with HOI. Operative factors, such as surgical procedure, approach, operative time and blood loss, were not significantly correlated with HOI. Using these clinical factors, the risk of HOI was classified by statistical partition. In this model, three factors (gender, age and WBC on postoperative day 1) were generated for the prediction of HOI. The patients were classified into five groups, and HOI was observed in 0-88% of patients in each group. The area under the curve (AUC) was 0.838. The model was validated by an external dataset in an independent patient group, for which the AUC was 0.792. In conclusion, HOI patients were classified and an HOI prediction model was developed that may help clinicians in postoperative care. IntroductionSurgery is an effective treatment for colorectal cancer (CRC) (1,2), and certain procedures, such as low anterior resection and intersphincteric resection for lower rectal cancer, require an ileostomy to reduce the risk of severe anastomotic leakage (3-5). High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6-8).The aim of the present study was to determine the frequency and risk factors of HOI and to create a prediction model of HOI. Predicting HOI may be useful for perioperative treatment. Patients and methodsPatients and data sets. A total of 68 consecutive patients who underwent surgery for colorectal cancer with ileostomy at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) between 2011 and 2016 were retrospectively analyzed. HOI was defined by a maximum output of >2,000 ml/day and high output (>1,000 ml/day) lasting for >3 days (Fig. 1). A total of 7 patients for whom detailed data of output were unavailable were excluded (Fig. 2). Based on a group of 50 patients who underwent surgery between 2011 and 2013, a decision tree was used to develop a prediction model for HOI. Clinicopathological factors, such as patient sex, age, body mass index, tumor stage, pr...

Organ/space infection is a common cause of high output stoma and outlet obstruction

“…The HOS and OO groups both had higher WBC counts and CRP levels on PODs 3 and 6 compared to the non-HOS and non-OO groups. The WBC count on POD 1 has previously been suggested to be a predictor of HOS [21], but this relationship was not significant in this study. The high WBC counts and CRP levels on PODs 3 and 6 show a prolonged postoperative infection in organ/space site, and suggest that intestinal edema and a prolonged decrease in intestinal absorption, which may be caused by infection in organ/space site, contribute to the pathology of HOS and OO.…”

Assessment of Risk Factors for the Occurrence of a High-Output Ileostomy

“…Older patient age was already included in risk analyses of previous works on HOS. However, there are no uniform results, since some studies also describe younger age as a risk factor for HOS (4,5,7,13). In contrast to our work, only patients with colorectal cancer were examined in the aforementioned studies.…”

“…The resulting complicated course may require longer hospital stays and repeated hospital stays. Although HOS is a known complication with an incidence of up to 18% (3), perioperative risk factors for the development of HOS are not yet sufficiently known, despite recent studies on this topic (4,5).…”

Advanced T stage and thick rectus abdominis muscle triggers outlet obstruction and high-output stoma following ileostomy in patients with rectal cancer

“…The risk factors of outlet obstruction have been reported to be operation type, high age, thick subcutaneous fat, and high white blood cell count [21]. Additionally, the risk factors of HOS have been reported to be abdominal sepsis, short bowel, obstruction, medication, overload with intravenous saline solution, enteritis, diabetes mellitus, proctocolectomy, high white blood cell count [18,19,[23][24][25][26]. However, there is no consistent theory to explain the cause and linkage of outlet obstruction and HOS.…”