Risk factors for bacterial translocation after loop ileostomy closure in patients with colorectal cancer.

PURPOSE: Although rare, septic shock can develop following the closure of an ileostomy created during colorectal cancer surgery. In such cases, bacterial translocation (BT) is considered the primary diagnosis, and appropriate treatment is provided. Herein, we investigated the risk factors of BT following ileostomy closure after colorectal cancer surgery.

METHODS

A retrospective analysis was conducted using the colorectal cancer database of Nagasaki University, focusing on 91 patients who received ileostomy closure after colorectal cancer surgery. The patients were divided into two groups based on the occurrence of BT, defined as fever exceeding 38 °C without an identifiable cause, and data regarding patient background, surgical factors, and postoperative factors were assessed.

RESULTS

BT occurred in 12 of 91 patients. No significant differences were observed between the groups of patients in terms of background factors but C-reactive protein levels on postoperative days 3 and 7 were significantly higher in the BT group than in the non-BT group (BT group vs. non-BT group [median], day 3: 6.64 mg/dL vs. 3.79 mg/dL, p = 0.0026; day 7: 5.10 mg/dL vs. 1.52 mg/dL, p = 0.0007). Additionally, the rate of postoperative adjuvant chemotherapy administration was significantly higher in the BT than in the non-BT group (BT group vs. non-BT group: 83.3% vs. 43.0%, p = 0.0123). The pathological findings from resected specimens showed that mucosal height was lower in the anal side than in the oral side.

CONCLUSION

Adjuvant chemotherapy may significantly increase the risk of BT after ileostomy closure following colorectal cancer surgery.