Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: the dilemma remains

• Published in: International journal of colorectal disease Vol. 34; no. 7; pp. 1151 - 1159
• Main Authors: Hajibandeh, Shahin, Hajibandeh, Shahab, Sarma, Diwakar Ryali, East, Jamie, Zaman, Shafquat, Mankotia, Rajnish, Thompson, Christopher Vaun, Torrance, Andrew W, Peravali, Rajeev
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2019; Springer; Springer Nature B.V
• Subjects: Adjuvant treatment; Aged; Anastomotic Leak - etiology; Cancer; Chemotherapy; Chemotherapy, Adjuvant; Clinical trials; Colorectal cancer; Colorectal carcinoma; Comparative analysis; Complications and side effects; Gastroenterology; Health risk assessment; Hepatology; Humans; Ileostomy; Ileus - etiology; Infection; Internal Medicine; Length of Stay; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Middle Aged; Ostomy; Postoperative Complications - etiology; Proctology; Quality of life; Rectal Neoplasms - drug therapy; Rectal Neoplasms - surgery; Rectum; Review; Surgery; Surgical site infections; Surgical Wound Infection - etiology; Stoma reversal, adjuvant chemotherapy; Loop ileostomy closure
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-019-03321-2

Objective To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov , ISRCTN Register and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed effects or random effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during ( n  = 185) or after ( n  = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82–2.36, p  = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47–16.56, p  = 0.26), surgical site infection (OR 1.97; 95% CI 0.80–4.90, p  = 0.14), ileus (OR 1.22; 95% CI 0.50–2.96, p  = 0.66) or length of hospital stay (MD 0.02; 95% CI − 0.85–0.89, p  = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of the best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to the closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on the completeness of chemotherapy and quality of life which can determine the appropriateness of either approach.