title: Effect of Diversion Ileostomy on the Occurrence and Consequences of Chemotherapy-Induced Diarrhea.
abstract: BACKGROUND
  The benefits of adjuvant chemotherapy in the treatment of colorectal cancer are well established. Chemotherapy-induced diarrhea is a common adverse effect of these regimens. The occurrence of chemotherapy-induced diarrhea not only directly affects patient health but may also compromise treatment efficacy because of consequent dosing alterations or discontinuation.
  
  
  OBJECTIVE
  This study aimed to investigate the effect of diverting loop ileostomy during chemotherapy on the occurrence and consequences of chemotherapy-induced diarrhea.
  
  
  METHODS
  This was a retrospective evaluation of a prospective surgical database.
  
  
  METHODS
  This was a single-institution retrospective study.
  
  
  METHODS
  All patients receiving curative adjuvant chemotherapy after anterior resection for colorectal cancer at Auckland Hospital from 2002 to 2013 were retrospectively evaluated.
  
  
  METHODS
  Patient-, perioperative-, and chemotherapy-related variables were collected. Chemotherapy-induced diarrhea occurrence was graded according to National Cancer Institute Common Terminology Criteria for Adverse Events. Logistic regression analysis was performed to identify independent predictors for chemotherapy-induced diarrhea occurrence, treatment modifications, and hospital admission.
  
  
  RESULTS
  A total of 109 identified patients received 691 chemotherapy cycles; 84% of patients with a diverting ileostomy experienced chemotherapy-induced diarrhea compared with 47% in those who were not defunctioned (p < 0.01). On logistic regression analysis, the presence of a diverting ileostomy during chemotherapy was an independent predictor of chemotherapy-induced diarrhea grade 3 or higher (OR, 13.6 (95% CI: 1.2-150.9); p = 0.02), the need for a dosing reduction (OR, 4.0 (95% CI: 1.3-12.4); p = 0.02), and the need for any modification in the chemotherapy regimen (OR, 3.4 (95% CI: 1.2-9.6); p = 0.02).
  
  
  CONCLUSIONS
  This study is limited by its retrospective design, potentially limiting the accuracy of chemotherapy-induced diarrhea grade reporting.
  
  
  CONCLUSIONS
  The presence of an ileostomy during adjuvant chemotherapy is a predictor of severe chemotherapy-induced diarrhea and the need for modifications in the chemotherapy regimen. This may have important consequences for long-term survival. Prospective investigation is needed to further assess the impact of diverting ileostomy on the delivery of chemotherapy and oncologic outcomes.
authors: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors: Jason P
authors: JP
authors: Robertson
authors: Cameron I
authors: CI
authors: Wells
authors: Ryash
authors: R
authors: Vather
authors: Ian P
authors: IP
authors: Bissett
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents