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Ileostomy-related dysbiosis after pelvic radiation in colorectal cancer
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Geriletu   , E. Li , L. Bao , Wurihan , X. Wang , Y. Wu |
| Department of General Surgery, Xilingol League Mongolian Medicine Hospital, Inner Mongolia Minzu University, Xilingol League, Inner Mongolia Autonomous Region, China , wudasheng1210@126.com |
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Abstract: (29 Views) |
Background: Gastrointestinal dysbiosis and inflammation are known complications of pelvic radiation for colorectal cancer, but the effect of diverting ileostomy is not known. This study explored whether ileostomy formation worsens radiotherapy-associated dysbiosis and related clinical complications. Materials and Methods: We performed a prospective matched cohort study of 120 patients with colorectal cancer receiving adjuvant pelvic radiotherapy, including 60 patients with diverting ileostomy and 60 matched non-ileostomy controls. All patients underwent pelvic intensity-modulated radiotherapy with total doses of 45–50.4 Gy in 25–28 fractions. Faecal samples or ileostomy effluent were obtained before radiotherapy, at week 3 and after completion of radiotherapy. Microbial composition was assessed by 16S rRNA sequencing. Alpha diversity, beta diversity, Microbial Dysbiosis Index, bacterial taxa, and clinical outcomes were compared between groups and timepoints. Results: Baseline microbial diversity and dysbiosis scores were similar across groups. Following radiotherapy, the ileostomy group showed a larger reduction in Shannon diversity compared to controls (2.1 ± 0.4 vs. 3.4 ± 0.5, p<0.001) and a higher Microbial Dysbiosis Index (8.2 ± 1.1 vs. 4.5 ± 0.9, p<0.001). Ileostomy patients showed significant depletion of Faecalibacterium prausnitzii and enrichment of Enterococcus faecalis, Clostridium difficile and Escherichia coli. They also had higher rates of dehydration, dermatitis, C. difficile infection and readmission. High dysbiosis post radiotherapy independently predicted readmission. Conclusion: Diverting ileostomy worsens pelvic radiotherapy-induced dysbiosis and is associated with higher treatment-related morbidity in patients with colorectal cancer. |
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| Keywords: Ileostomy, dysbiosis, pelvic radiation, colorectal cancer, microbiome, Clostridium difficile. |
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Full-Text [PDF 745 kb]
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Type of Study: Original Research |
Subject:
Radiation Biology
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