Contemporaneous network analysis characterizes symptom-network topology and core symptoms in patients with a stoma after colorectal cancer surgery

Symptoms co-occur after colorectal cancer stoma surgery, but their network roles remain unclear. This two-center cross-sectional study included 331 consecutively recruited patients. Exploratory factor analysis identified five symptom clusters: Psychological, Peristomal Skin, Energy Deficit, Digestive-Urinary System, and Pain. Apriori association-rule analysis identified weight loss, social impairment, and mucus discharge from the anus as sentinel symptoms within the Energy Deficit, Psychological, and Digestive-Urinary System clusters, respectively; these labels reflect cross-sectional association patterns rather than temporal ordering. In the EBICglasso network, decreased subjective well-being had the highest standardized Expected Influence ( z = 1.25) and standardized one-step Bridge Expected Influence ( z = 4.74). Complementary nodewise regression yielded R 2 = 0.634 for this symptom, and the correlation-stability coefficient for Expected Influence was 0.749. Multivariable models for the core and sentinel symptom scores explained 7.8%–23.9% of the variance, indicating modest explanatory performance. These pooled findings may inform symptom assessment but may differ across postoperative phases; the mucus-discharge finding is further limited by unrecorded anatomical eligibility. Longitudinal studies should test temporal ordering and predictive utility.