The Effect of Adjuvant Chemotherapy on Stoma-Related Complications After Surgery for Colorectal Cancer: A Retrospective Analysis.
OBJECTIVE
To assess stoma-related complications of colorectal cancer patients undergoing surgery with curative intent who received adjuvant chemotherapy compared to those who underwent surgery alone.


METHODS
A retrospective analysis of a prospectively maintained colorectal cancer clinical audit database was completed.


METHODS
Patients undergoing curative surgery for colorectal cancer with the formation of a stoma (end ileostomy, loop ileostomy, end colostomy) between 1999 and 2011 at a single hospital in Lanarkshire, United Kingdom. Patients who underwent neo-adjuvant chemotherapy were excluded. Two hundred twenty-two patients comprised the study sample; 130 (59%) were male. Seventy-five (34%) patients comprised the chemotherapy group and 147 (66%) made up the surgery-only group. Patients in the chemotherapy group were younger (61.6 vs 65.4 years; P = .001) and had higher stage colorectal cancer (P < .001). There was no difference in baseline (day 10) stoma scores between the chemotherapy or surgery-only groups.


METHODS
Postoperative stoma-related complications were serially assessed using a stoma complication scoring tool; scores were calculated at 10 days and 3 months postoperatively. Scores of patients receiving adjuvant chemotherapy were compared to scores of participants who underwent surgery alone.


METHODS
A composite stoma function score was calculated for each patient after assessment of stoma-related complications. The overall score included a global assessment of stoma quality (stoma retraction, prolapse, stenosis, parastomal hernia, skin changes) and patient-reported stoma function (leakage, soiling, nighttime emptying, odor).


RESULTS
At 3 months, the mean loop ileostomy stoma function score was poorer among the chemotherapy group when compared to the surgery-only group (4.55 vs 1.53; P = .041). No differences were found when colostomy (2.00 vs 2.62; P = .411) or end ileostomy (1.00 vs 2.00; P = .170) function scores were compared at 3 months.


CONCLUSIONS
Patients undergoing curative surgery for colorectal cancer resulting in a loop ileostomy who received adjuvant chemotherapy had higher stoma complication scores at 3 months compared to those who underwent surgery with no chemotherapy. This difference was not seen in patients with colostomies or end ileostomies. Patients, WOC nurses, and medical staff must be alert to the potential of increased loop ileostomy-related complications with adjuvant chemotherapy. Fully informed patient consent coupled with timely support and advice may reduce stoma-related morbidity and improve quality of life for such patients.
Raymond Oliphant, BMedSci(Hons), MD, FRCS, Department of Surgery, Monklands District General Hospital, Airdrie, United Kingdom. Alex Czerniewski, MBChB, Department of Surgery, Monklands District General Hospital, Airdrie, United Kingdom. Isabell Robertson, BSc, Department of Surgery, Monklands District General Hospital, Airdrie, United Kingdom. Clare McNulty, Department of Surgery, Monklands District General Hospital, Airdrie, United Kingdom. Ashita Waterston, BSc, MBChB, MRCP, PhD, Beatson Oncology Centre, Gartnavel General Hospital, Glasgow, United Kingdom. Angus Macdonald, MD, FRCS Department of Surgery, Monklands District General Hospital, Airdrie, United Kingdom.
Raymond
R
Oliphant
Alex
A
Czerniewski
Isabell
I
Robertson
Clare
C
McNulty
Ashita
A
Waterston
Angus
A
Macdonald
D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*