Predictors and clinical impact of postoperative diarrhea after colorectal cancer surgery: a prospective, multicenter, observational study (SHISA-1602)

Abstract

Purpose Postoperative diarrhea, including high-output stoma (HOS), frequently occurs after colorectal surgery; its risk factors and clinical implications on subsequent complications remain unknown. This study aimed to evaluate the risk factors and clinical implications of postoperative diarrhea after primary colorectal cancer (CRC) surgery. Methods This prospective observational study included patients with CRC who underwent radical surgery at six hospitals between June 2016 and December 2017. The patients were categorized into three groups (non-stoma, colostoma, and ileostoma groups). Results A total of 178 patients participated in the study. In the non-stoma group, the incidence of postoperative diarrhea was 18.4% (27/147). The incidence of HOS was 28.6% (4/14) in the ileostoma group, and 0% in the colostoma group. Multivariable analyses of the incidence of diarrhea in the non-stoma group indicated that habitual smoking and hypertension were significantly associated with postoperative diarrhea (P = 0.012 and P = 0.0274, respectively). Postoperative diarrhea was more likely to occur in patients with rectal cancer than in those with colon cancer (P = 0.0501). In the non-stoma and ileostoma groups, the probability of the occurrence of other complications with Clavien–Dindo (C-D) grades II or higher was significantly higher in patients with C-D grade I diarrhea, including HOS, than in patients without diarrhea (39.3% vs. 14.6%, P = 0.0061). Conclusions Smoking and hypertension are the independent predictors of postoperative diarrhea after an elective CRC surgery. Rectal cancer surgery seems to be associated with postoperative diarrhea more than colon cancer surgery does. Mild postoperative diarrhea may lead to more severe complications.

Clinical practice guidelines for prevention and treatment of postoperative gastrointestinal disorder with Integrated Traditional Chinese and Western Medicine (2023)

“…For patients with gastrointestinal cancer, they were susceptible to diarrhea because their intestinal mucosa was injured due to multiple factors preoperative bowel preparation, intraoperative vagotomy, perioperative antibiotic use, and chemotherapy drugs, leading to reduced absorption area and impaired absorption function in the intestinal mucosa. A prospective, multicenter clinical study reported that the diarrhea incidence after intestinal tumor surgery was as high as 18.4% 56 . Postoperative diarrhea was also a common cause of chronic diarrhea.…”

“…A prospective, multicenter clinical study reported that the diarrhea incidence after intestinal tumor surgery was as high as 18.4%. 56 Postoperative diarrhea was also a common cause of chronic diarrhea. It occurred frequently and was difficult to recover, so patients were usually painful with low life quality.…”

Obstructive and secretory complications of diverting ileostomy

“…The incidence of HOS varies from 14% to 24%[ 29 , 41 - 43 ] with various definitions. The majority of previous reports have defined using specific values of output volume with a timeframe, such as 2000 mL per day[ 38 , 44 , 45 ], 1500 mL per day for two days[ 41 ], 1000 mL per day for three days[ 42 , 46 ], and 2000 mL per day for three days[ 29 , 43 ]. Some authors have used a combination of output volume with laboratory findings of renal impairment and/or physical signs of dehydration[ 36 , 47 ].…”

Clostridioides difficile infection following ileostomy reversal – can we clean up our act?

“…For example, a recent retrospective study of 178 ileostomy reversal patients found that 29 (16.3%) developed mild non-CD diarrhoea. 10 These symptoms are often ascribed to normal colonic readaptation after disuse or altered bowel function as part of low anterior resection syndrome. Thus, many patients with diarrhoea following ileostomy reversal are not tested for CD, especially if symptoms develop after discharge from hospital.…”

“…This is because mild‐to‐moderate diarrhoea after ileostomy reversal is common. For example, a recent retrospective study of 178 ileostomy reversal patients found that 29 (16.3%) developed mild non‐CD diarrhoea 10 . These symptoms are often ascribed to normal colonic readaptation after disuse or altered bowel function as part of low anterior resection syndrome.…”