Risk Factors of Delayed Recovery of Gastrointestinal Function After Ileostomy Reversal for Rectal Cancer Patients

Figures & data

Figure 1 Flow chart of rectal cancer patient selection for this study.

Table 1 Comparison of the Demographic and Clinical Characteristics

Variables	Early Flatus Group (n=119)	Delayed Flatus Group (n=163)	P
Age, median (IQR)	59 (49, 66)	61(53, 68)	0.053
Male, n (%)	82 (68.9)	106 (65.0)	0.495
Drinking history, n (%)	2 (1.7)	1 (0.6)	0.783
Smoking status, n (%)	4 (3.4)	7 (4.3)	0.930
Concomitant disease, n (%)	29 (24.4)	35 (21.5)	0.175
Tumor recurrence or metastasis, n (%)	6 (5.0)	7 (4.3)	0.767
BMI <18.5 kg/m^2, n (%)	14 (11.8)	13 (8.0)	0.566
pTNM stages of the primary tumor, n (%)			0.946
0	12 (10.1)	17 (10.4)
I	33 (27.7)	48 (29.4)
II	43 (36.1)	50 (30.7)
III	25 (21.0)	40 (24.5)
IV	6 (5.0)	8 (4.9)
Distance from the primary tumor to the anus <5 cm, n (%)	65 (54.6)	72 (44.2)	0.083
Chemotherapy, n (%)	75 (63.0)	100 (61.3)	0.775
Radiotherapy, n (%)	16 (13.4)	25 (15.3)	0.656
Surgical approach of primary tumor resection, n (%)			0.102
Dixon	61 (51.3)	93 (57.1)
Parks	21 (17.6)	40 (24.5)
Bacon	4 (3.4)	4 (2.5)
TaTME	33 (27.7)	26 (20.0)
Duration of stoma ≥6 months, n (%)	32 (26.9)	64 (39.3)	0.030
Operative duration of ileostomy reversal, min, median (IQR)	82 (60,105.5)	95 (60,123)	0.022
Methods of anastomosis			0.326
Suture	24 (20.2)	41 (25.2)
Stapled	95 (79.8)	122 (74.8)
Intravenous fluid volume during ileostomy reversal surgery, mL, median (IQR)	1300 (1100, 1600)	1300 (1100, 1600)	0.179
Intravenous fluid infusion in POD1, mL, median (IQR)	2400 (1900, 2700)	2740 (2350, 3070)	0.000
Complications after primary procedure, n (%)	63 (52.9)	72 (44.2)	0.145

Abbreviations: POD1, postoperative day 1; IQR, interquartile range.

Table 2 Multivariate Logistic Regression Analysis

Variables	B	OR	95%CI Lower Limit–Higher Limit	P
Intravenous fluid infusion in POD1	0.001	1.001	1.001–1.002	0.001
Duration of stoma ≥6 months	0.720	2.005	1.155–3.657	0.014

Abbreviations: POD1, postoperative day 1; OR, odds ratio; CI, confidence interval.

Figure 2 ROC curve of a new model for predicting the delayed flatus after ileostomy reversal in rectal cancer patients ROC AUC was 0.704 (95% CI: 0.647–0.757, P<0.001). When the Hosmer-Lemeshow method was used, the value of X² was 10.399, P > 0.05.

Abbreviations: ROC, receiver operating characteristic; AUC, area under the receiver-operating characteristic curve.

Figure 3 Association of delayed flatus with duration of stoma (A) or fluid infusion (B) the proportions of delayed flatus almost increased as the duration of stoma or intravenous fluid infusion POD1 increased.

Abbreviation: POD1, postoperative day 1.