From the Research
Chemotherapy can be started as early as 2-4 weeks after a diverting ostomy procedure, but the optimal time is within 8 weeks after surgery, as delaying initiation for more than 8 weeks is associated with poor overall survival. The decision on when to start chemotherapy should be based on individual patient factors, including overall health status, nutritional state, wound healing progress, and the specific type of cancer being treated 1. Patients should have adequate recovery from surgery with stable ostomy function, good nutritional parameters, and resolution of any post-surgical complications before initiating chemotherapy.
The timing of chemotherapy initiation is crucial, as it can impair wound healing and immune function, potentially leading to complications if started too early. Additionally, patients should be educated about ostomy care during chemotherapy, as treatment may cause increased output or skin irritation around the stoma. Regular assessment of the stoma and surrounding skin is essential during chemotherapy to identify and address any complications promptly.
Some studies suggest that the completion rate of adjuvant chemotherapy in patients with diverting ileostomy is lower than that of colorectal cancer patients without ileostomy, and that certain chemotherapy regimens, such as UFT/LV, may be more tolerable than others, such as Capecitabine or CAPOX, in patients with diverting ileostomy 2. However, the most recent and highest-quality study suggests that delaying the initiation of adjuvant chemotherapy for more than 8 weeks after surgery is significantly associated with poor overall survival, and that starting chemotherapy within 8 weeks after surgery brings more benefits to colorectal cancer patients 1.
Key factors to consider when deciding on the timing of chemotherapy initiation include:
- Patient's overall health status and nutritional state
- Wound healing progress and presence of any post-surgical complications
- Specific type of cancer being treated and its aggressiveness
- Patient's ability to tolerate chemotherapy and potential side effects
- Presence of any comorbidities or underlying health conditions that may affect chemotherapy tolerance.
Ultimately, the decision on when to start chemotherapy should be made collaboratively between the surgical team and oncologists, taking into account individual patient factors and cancer-specific considerations.