Longitudinal Evaluation of Bowel Function Recovery and Determinants in Colorectal Cancer Patients Postileostomy: A...

The aim of this study was to longitudinally observe bowel function changes in colorectal cancer (CRC) patients postileostomy, analyse factors influencing recovery and provide a multidimensional assessment to enhance understanding of early postoperative bowel function and its determinants, supporting personalized care strategies.

A prospective longitudinal study was conducted on 116 CRC patients postileostomy at a tertiary hospital in Guangdong Province. After exclusions, data from 102 participants were analysed. Data were collected at four time points: preoperative admission, postoperative day 5, 1 month and 2 months after surgery. Validated tools, including the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC BFI), the International Physical Activity Questionnaire Short Form (IPAQ-SF), the Self-Rating Anxiety Scale (SAS), the Stoma Self-Efficacy Scale (SSES) and the Stoma-Quality of Life (Stoma-QOL) questionnaire, were used. Generalized estimating equations analysed associations between bowel function and demographic, clinical and lifestyle factors such as age, gender, comorbidities and physical activity.

BFI scores significantly improved from 69.00 (SD = 7.00) at admission to 47.00 (SD = 5.00) at 2 months postsurgery (p < 0.05). Physical activity levels declined initially (postoperative day 5) but gradually recovered over time (p < 0.05). SAS scores peaked on postoperative day 5 and then declined (p < 0.05). Both SSES and Stoma-QOL scores improved significantly over 2 months (p < 0.05). Several factors significantly influenced changes in bowel function, including demographic and clinical characteristics, physical activity, anxiety, self-efficacy and quality of life (p < 0.05). Generalized estimating equations revealed that bowel function improved over time, influenced by age, gender, adjuvant therapy, ostomy output, complications and self-efficacy (p < 0.05).

Recovery of bowel function after ileostomy is a dynamic process influenced by various demographic, clinical and psychosocial factors, emphasizing the need for tailored rehabilitation strategies.

What is already known about this topic? Colorectal cancer is a leading cause of morbidity and mortality, with an increasing number of patients requiring ileostomy. Ileostomy reduces perioperative risks but often leads to significant bowel dysfunction, negatively impacting quality of life. Most studies have focused on short-term bowel function recovery during hospitalization, neglecting long-term recovery in Chinese patients. What this paper adds? This study provided a longitudinal analysis of bowel function recovery in colorectal cancer patients postileostomy, from admission to 2 months after surgery, using a multifaceted assessment approach. Findings showed that bowel function declined immediately postsurgery but gradually improved, with key predictors of recovery such as age, gender, education, physical activity, anxiety, self-efficacy and quality of life. Stoma complications, such as anastomotic leaks and infections, along with high output stomas, delayed recovery and highlighted the need for targeted clinical interventions. The implications of this paper: Personalized rehabilitation strategies are crucial for improving recovery outcomes in colorectal cancer patients postileostomy. Early interventions should focus on physical activity, psychological support and enhancing self-efficacy. Nurses should regularly assess bowel function and promptly address stoma complications to optimize recovery, emphasizing tailored, evidence-based approaches for high-risk patients.