Zhonghua Wei Chang Wai Ke Za Zhi. 2026 Jan 25;29(1):92-97. doi: 10.3760/cma.j.cn441530-20250415-00160.
ABSTRACT
Objective: To characterize the endoscopic severity distribution and clinical features of diversion colitis (DC) following curative resection for rectal cancer with concurrent ileostomy. Methods: This descriptive observational study enrolled patients who met the following criteria: (1) preoperative histopathological confirmation of primary rectal adenocarcinoma via colonoscopic biopsy; (2) curative rectal cancer surgery (open or laparoscopic) with simultaneous prophylactic loop ileostomy; (3) subsequent ileostomy closure; and (4) complete medical records of 1-month follow-up data after closure. Patients who underwent abdominoperineal resection or had inadequate bowel preparation precluding clear endoscopic mucosal visualization were excluded. Clinical data were retrospectively collected for 173 patients who underwent the aforementioned procedures at Peking University People’s Hospital between January, 2023 and December, 2024. Primary endpoints were the overall incidence of endoscopic DC, its severity distribution (mild, moderate, severe), and specific manifestations (edema, mucosal hemorrhage, and contact bleeding). Secondary endpoints included the low anterior resection syndrome (LARS) score [range 0-42; no LARS (0-20), minor LARS (21-29), major LARS (30-42)] and bowel function-related symptoms (abdominal pain, mucous stool, rectal bleeding before and after closure, and diarrhea after closure). Results: Among the cohort, 108 patients (62.4%) were male, with a median age of 67 years (IQR 59-73). Endoscopic assessment revealed a 100% overall incidence of DC. Moderate to severe edema was present in 113 patients (65.3%), mucosal hemorrhage in 105 (60.7%), and contact bleeding in 66 (38.2%). Based on DC severity scores, cases were classified as mild in 52 (30.1%), moderate in 72 (41.6%), and severe in 49 (28.3%). Compared to the mild/moderate DC group, the severe DC group had a significantly longer median time to stoma closure [5.7 months (IQR 3.8, 7.7) vs. 4.7 months (IQR 3.7, 5.9); Z=2.335, P=0.020] and higher C-reactive protein levels (P=0.002). The severe DC group also exhibited higher incidences of pre-closure abdominal pain [20.4% (10/49) vs. 8.1% (10/124); χ²=5.234, P=0.022] and post-closure rectal bleeding [18.4% (9/49) vs. 8.1% (10/124); χ²=3.813, P = 0.049]. Furthermore, the severe DC group had a higher median LARS total score [31 (IQR 27, 38) vs. 27 (IQR 15, 34); Z=2.370, P=0.018] and a significantly greater proportion of patients with clustered defecation [59.2% (29/49) vs. 37.1% (46/124); χ²=6.977, P=0.031]. There were no statistically significant in other defecation function related symptoms between the two groups (all P>0.05). Conclusion: DC is an extremely common finding after curative rectal cancer surgery with concurrent ileostomy. Severe DC is associated with a longer interval to stoma closure, elevated inflammatory markers, and inferior postoperative bowel function.
PMID:41566186 | DOI:10.3760/cma.j.cn441530-20250415-00160
