Predisposing factors and clinical impact of high-output syndrome after sphincter-preserving surgery with covering ileost
- PDF / 786,196 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 69 Downloads / 177 Views
ORIGINAL ARTICLE
Predisposing factors and clinical impact of high‑output syndrome after sphincter‑preserving surgery with covering ileostomy for rectal cancer: a retrospective single‑center cohort study Ryota Nakanishi1 · Tsuyoshi Konishi1 · Erika Nakaya2 · Yoko Zaitsu1 · Toshiki Mukai1 · Tomohiro Yamaguchi1 · Toshiya Nagasaki1 · Takashi Akiyoshi1 · Satoshi Nagayama1 · Yosuke Fukunaga1 Received: 29 June 2020 / Accepted: 24 August 2020 © Japan Society of Clinical Oncology 2020
Abstract Background Ileostomy-related high-output syndrome has become a major cause of postoperative morbidity after rectal cancer surgery. This study aimed to clarify the predisposing factors and clinical impact of high-output syndrome. Methods Clinical parameters that were associated with high-output syndrome and clinical impact of high-output syndrome on nutritional status, electrolyte abnormality and renal dysfunction were retrospectively investigated in consecutive patients with rectal cancer undergoing resection with covering ileostomy during 2016–2017. Results High-output syndrome developed in 44/195 eligible patients (22.6%). Multivariable analysis revealed that neoadjuvant (chemo)radiotherapy [odds ratio (OR): 2.4; 95% confidence interval (CI) 1.1–5.2; P = 0.02], postoperative complications (OR: 2.2; 95% CI 1.0–4.6; P = 0.049), postoperative maximal white blood cell ≥ 10,000 cells/μl (OR: 4.0; 95% CI 1.9–8.8; P = 0.0004), and postoperative maximal C-reactive protein ≥ 10 mg/dl (OR: 2.4; 95% CI 1.1–5.2; P = 0.02) were independently associated with high-output syndrome. High-output syndrome was associated with increased renal dysfunction at the time of ostomy closure (29.6% versus 11.9%, patients with high-output syndrome vs. without high-output syndrome, P = 0.008), but not with nutritional imbalance or electrolyte abnormalities. High-output syndrome (OR: 2.5; 95% CI 1.1–5.9; P = 0.03) and postoperative maximal C-reactive protein ≥ 10 mg/dl (OR: 2.4; 95% CI 1.0–5.6; P = 0.04) were independently associated with renal dysfunction at ostomy closure. Conclusion Preoperative (chemo)radiotherapy, postoperative inflammatory response, and postoperative complications predisposed to high-output syndrome, and it significantly impacted postoperative renal dysfunction. Active monitoring and early intervention are warranted to prevent renal dysfunction in patients with these factors. Keywords High-output syndrome · Rectal cancer · Ileostomy · Renal dysfunction · Sphincter-preserving surgery · Predisposing factor
Ryota Nakanishi and Tsuyoshi Konishi contributed equally to this work as the co-first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10147-020-01781-z) contains supplementary material, which is available to authorized users. * Tsuyoshi Konishi tkonishi‑[email protected] 1
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31‑8‑3 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
Clinical Nutrition, Cancer Institut
Data Loading...
