Observational Study
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World J Gastroenterol. Feb 28, 2020; 26(8): 850-864
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.850
Table 1 Demographics and characteristics
Variable Diverting colostomy, n = 14 Conservative treatment, n = 25 Colostomy vs conservative, P value ITT group, n = 50 ITT group vs colostomy, P value Age, mean ± SD 61 ± 10.9 60.2 ± 2.4 0.89 59.3 ± 8.7 0.767 Sex, female/male 13/1 23/2 1.01 49/1 1.01 Primary cancer 0.405 0.879 Cervical cancer 12 21 45 Endometrial cancer 0 2 2 Rectal cancer 2 1 2 Prostate cancer 0 1 1 Radiation dosage, Gy 82 ± 15.9 83.6 ± 20.5 0.825 83.4 ± 18.5 0.553 Duration of bleeding in mo 13 ± 4.3 8.0 ± 1.8 0.042 11.3 ± 4.0 0.263 Pre-Op transfusion, yes/no 12/2 6/19 < 0.001 - - Pre-Op Hb, g/L (lowest level) 63 ± 17.8 88.2 ± 19.3 < 0.001 80 ± 27.8 0.051 Bleeding remission rate Post-Op 3 mo 12/14 (86%) 1/25 (4%) < 0.001 - - Post-Op 6 mo 12/14 (86%) 3/25 (12%) < 0.001 - - Post-Op 9 mo 13/14 (93%) 5/25 (20%) < 0.001 - - Post-Op 1 yr 14/14 (100%) 6/25 (24%) < 0.001 - - Post-Op 2 yr 14/14 (100%) 5/25 (20%) < 0.001 - - Bleeding score at initial diagnosis 2.7 ± 0.5 2.0 ± 0.5 < 0.001 - - Bleeding score after 1 yr of treatment 0.8 ± 0.5 1.7 ± 0.9 0.008 2.4 ± 0.5 0.033
Table 2 Clinical details and outcomes of 14 colostomy patients
Characteristic Case Median (range or %) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Age 70 83 49 48 59 72 58 73 56 47 63 68 46 59 61 (47-83) Sex F F F F F F M F F F F F F F 13 (F, 93%) Primary cancer Cervix Cervix Cervix Cervix Cervix Cervix Rectum Cervix Cervix Anus Cervix Cervix Cervix Cervix 12 (Cervix, 86%) Radiation dosage, Gy 98 80 96 60 80 78 50 80 80 84 86 74 120 80 82 (50-120) Duration of bleeding in mo 19 15 14 21 15 18 8 7 15 10 10 8 11 10 13 (7-21) Pre-Op transfusion (U) 5 8 4 2 4 8 4 - 4 2 2 2 2 - 12 (Yes, 86%) Duration of stoma in mo 48 34 18 10 34 9 26 15 12 53 10 15 14 16 (9-53) Indication(s) for colostomy Severe anemia Severe anemia Severe anemia Severe anemia Severe anemia Severe anemia Severe anemia Moderate anemia + perianal pain Severe anemia Severe anemia + perianal pain Severe anemia Severe anemia Severe anemia Severe anemia+ sigmoid colon sclerosis - Hb, g/L Pre-Op Hb 44 36 76 63 36 35 71 87 52 78 72 78 76 78 63 (35-87) Post-Op 3 mo 85 - 85 - - 45 87 - - - - - - - 75 (45-87) Post-Op 6 m - - - - 94 - - 77 - - 108 118 - - 99 (77-118) Post-Op 9 mo - - - 102 - 75 120 - - - - 117 122 - 107 (75-120) Post-Op 1 yr - - - 100 113 - - 123 114 114 - - - 105 111 (100-123) Post-Op 2 yr - - 118 102 - 111 135 130 114 - 110 - 117 - 117 (102-135) Post-Op transfusion No Yes No No No yes No yes No No No No No No Stoma closure Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 13 (Yes, 93%) Stoma complications Hernia - - - - - Prolapse - Obstruction - - - - - 3 (Yes, 21%) Pre-Op bleeding score 3 3 3 3 3 3 3 2 2 3 2 3 3 3 3 (2-3)1 Bleeding score at stoma reversal - - 1 1 1 1 - 1 0 0 - 0 1 1 1 (0-1)1 Treatment after stoma - - - - - APC 1 Formalin 1 APC 1 - - APC 1 - - -
Table 3 Magnetic resonance imaging findings at post-colostomy and at reversal compared in 5 patients with chronic radiation proctopathy
Variable, mm Pre-colostomy, mean ± SD At reversal, mean ± SD P value, paired t -test Thickness of rectal wall 10.76 ± 4.29 8.91 ± 1.61 0.047 Width of presacral space 15.57 ± 8.86 15.84 ± 4.11 0.328 Thickness of left levator ani 2.81 ± 1.07 3.18 ± 1.39 0.341 Thickness of right levator ani 3.42 ± 1.26 3.45 ± 1.66 0.944 Thickness of left gluteus maximus muscle 31.36 ± 3.80 32.21 ± 9.0 0.769 Thickness of right gluteus maximus muscle 29.89 ± 4.19 32.15 ± 11.95 0.693 Thickness of left obturator internus 15.16 ± 1.97 17.89 ± 1.77 0.160 Thickness of right obturator internus 13.79 ± 4.90 14.36 ± 5.50 0.060 Thickness of distal part of sigmoid colon 4.50 ± 0.73 5.08 ± 1.17 0.503
Table 4 Rectal manometry assessment of anorectal functions before stoma reversals
Patient Tensity of anorectal ring Function of contraction Diagnosis Sensitivity of rectal mucosa Rectal volume Repression of anorectum reflex Anal relaxation when simulating defecation 1 Increase Good Internal sphincter spasm Increase Normal Normal Good 4 Increase Good - Normal Decrease Normal Good 6 Decrease Decrease Decreased sphincter function Increase Decrease Normal Good 9 Normal Decrease Decreased sphincter function Increase Decrease Abnormal Good 12 Normal Decrease - Increase Decrease Good 14 Normal Good - Increase Decrease Abnormal Good
Table 5 Quality of life in the colostomy group and conservative group of chronic radiation proctopathy patients based on the EORTC QLQ-C30 scale
QLQ-C30 scale Reference: Normal German population Colostomy group, n = 14, mean ± SD Conservative group, n = 25, mean ± SD Pretreat-ment Follow-up Δ(FU)-Pre2 Signifi-cance1 Pretreat-ment Follow-up Δ(FU)-Pre Signifi-cance1 Global health 63.2 23.1 ± 15.1 63.1 ± 18.3 40 < 0.001 47.1 ± 21.5 62.3 ± 25.0 15.2 0.033 Physical function 82.6 50.7 ± 17.8 87.1 ± 13.7 36.4 < 0.001 78.0 ± 22.7 78.6 ± 26.1 0.6 0.856 Role function 75 34.3 ± 23.9 89.3 ± 20.5 55 < 0.001 77.5 ± 24.9 77.5 ± 29.1 0 0.775 Emotional function 62.2 46.3 ± 27.4 85.7 ± 14.9 39.4 < 0.001 75.7 ± 17.6 80.8 ± 23.8 5.1 0.384 Cognition function 81.3 92.6 ± 12.7 95.2 ± 9.8 2.6 1.0 94.2 ± 15.6 95.7 ± 9.0 1.5 0.798 Social function 78.4 43.5 ± 28.9 79.8 ± 18.0 36.3 < 0.001 91.3 ± 20.6 89.1 ± 21.1 -2.2 0.916 Fatigue 34.1 72.8 ± 12.9 10.3 ± 18.5 -62.5 < 0.001 26.6 ± 24.1 23.2 ± 27.2 -3.4 0.695 Nausea/ vomiting 5.7 4.6 ± 15.5 0 ± 0 -4.6 - 5.1 ± 15.4 6.5 ± 16.5 1.4 0.655 Pain 33.1 44.4 ± 28.3 9.5 ± 15.1 -34.9 < 0.001 14.5 ± 21.5 11.6 ± 18.4 -2.9 0.481 Dyspnea 18.8 42.6 ± 31.0 4.8 ± 11.7 -37.8 < 0.001 14.5 ± 19.7 8.7 ± 18.0 -5.8 0.210 Insomnia 38.5 48.1 ± 35.5 11.9 ± 20.3 -36.2 < 0.001 21.7 ± 21.6 26.1 ± 31.7 4.4 0.287 Appetite loss 9.4 22.2 ± 27.2 0 ± 0 -22.2 - 10.1 ± 25.5 8.7 ± 18.0 -1.4 0.785 Constipation 9.1 9.3 ± 14.9 9.5 ± 15.1 -0.2 1.0 8.7 ± 20.6 7.2 ± 22.4 -1.5 0.414 Diarrhea 9.2 33.3 ± 33.3 9.5 ± 26.5 -23.8 < 0.001 11.6 ± 23.8 2.9 ± 9.6 -8.7 0.078 Financial difficulties 17.1 59.3 ± 26.2 23.8 ± 31.9 -35.5 < 0.001 26.1 ± 31.7 24.6 ± 30.5 -1.5 0.595
Citation: Yuan ZX, Qin QY, Zhu MM, Zhong QH, Fichera A, Wang H, Wang HM, Huang XY, Cao WT, Zhao YB, Wang L, Ma TH. Diverting colostomy is an effective and reversible option for severe hemorrhagic radiation proctopathy. World J Gastroenterol 2020; 26(8): 850-864
URL: https://www.wjgnet.com/1007-9327/full/v26/i8/850.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i8.850