Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis

Wang, Li; Chen, Xinling; Liao, Chen Di; Wu, Qian; Luo, Haiwei; Yi, Fengming; Wei, Yiping

doi:10.1007/s00595-020-02115-2

Cited by 18 publications

(18 citation statements)

References 26 publications

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“…This study suggested that there was no relationship between the interval between the index surgery and ileostomy closure and postoperative ileus after ileostomy closure [13]. Previous study also reported that postoperative complication was similar in early ileostomy closure group and late closure group [14].…”

Section: Discussionmentioning

confidence: 55%

Risk Factors for Postoperative Ileus after Diverting Loop Ileostomy Closure following Rectal Cancer Surgery: A Retrospective Study

Nakao

Shimada

Yoshikawa

et al. 2021

Preprint

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Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure.Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus (POI (+)) and patients who did not (POI (−)) after ileostomy closure were compared.Results: Fifty-nine patients were evaluated and were divided into two groups: POI (+) (n=9) and POI (−) (n=50), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications after the index surgery was significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications after the index surgery may increase the risk of postoperative ileus after ileostomy closure.

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Section: Discussionmentioning

confidence: 55%

Risk Factors for Postoperative Ileus after Diverting Loop Ileostomy Closure following Rectal Cancer Surgery: A Retrospective Study

Nakao

Shimada

Yoshikawa

et al. 2021

Preprint

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“…There are no specific guidelines or timing for assessing the most suitable LIC duration (28). Although there are studies reporting 1-12 weeks for early LIC and 2-6 months for late LIC, LIC duration is usually performed after 8-12 weeks (29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

“…Although there are studies reporting 1-12 weeks for early LIC and 2-6 months for late LIC, LIC duration is usually performed after 8-12 weeks (29)(30)(31). Early LIC is associated with more overall complications and wound complications after closure, and it may delay the completion of adjuvant chemotherapy (28,32). Therefore, early LIC is not generally recommended for patients with rectal cancer (28).…”

Section: Discussionmentioning

confidence: 99%

“…Early LIC is associated with more overall complications and wound complications after closure, and it may delay the completion of adjuvant chemotherapy (28,32). Therefore, early LIC is not generally recommended for patients with rectal cancer (28). Conversely, having ileostomy during adjuvant chemotherapy has been shown to increase stoma output, leading to dehydration, electrolyte disturbances, and renal failure (28,33).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early LIC is not generally recommended for patients with rectal cancer (28). Conversely, having ileostomy during adjuvant chemotherapy has been shown to increase stoma output, leading to dehydration, electrolyte disturbances, and renal failure (28,33). In a recent meta-analysis, it has been found that LIC during or after adjuvant chemotherapy does not change the risk of POI (34).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors for postoperative ileus following loop ileostomy closure

et al. 2020

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Early versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a meta-analysis and trial sequential analysis of safety and functional outcomes

Podda

Coccolini²,

Gerardi

et al. 2022

Int J Colorectal Dis

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Purpose We performed a systematic review and meta-analysis with trial sequential analysis (TSA) to answer whether early closure of defunctioning ileostomy may be suitable after low anterior resection. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, up to October 2021, for RCTs comparing early closure (EC ≤ 30 days) and delayed closure (DC ≥ 60 days) of defunctioning ileostomy. The risk ratio (RR) with 95% CI was calculated for dichotomous variables and the mean difference (MD) with 95% CI for continuous variables. The GRADE methodology was implemented for assessing Quality of Evidence (QoE). TSA was implemented to address the risk of random error associated with sparse data and/or multiple testing. Results Seven RCTs were included for quantitative synthesis. 599 patients were allocated to either EC (n = 306) or DC (n = 293). EC was associated with a higher rate of wound complications compared to DC (RR 2.56; 95% CI 1.33 to 4.93; P = 0.005; I2 = 0%, QoE High), a lower incidence of postoperative small bowel obstruction (RR 0.46; 95% CI 0.24 to 0.89; P = 0.02; I2 = 0%, QoE moderate), and a lower rate of stoma-related complications (RR 0.26; 95% CI 0.16 to 0.42; P < 0.00001; I2 = 0%, QoE moderate). The rate of minor low anterior resection syndrome (LARS) (RR 1.13; 95% CI 0.55 to 2.33; P = 0.74; I2 = 0%, QoE low) and major LARS (RR 0.80; 95% CI 0.59 to 1.09; P = 0.16; I2 = 0%, QoE low) did not differ between the two groups. TSA demonstrated inconclusive evidence with insufficient sample sizes to detect the observed effects. Conclusion EC may confer some advantages compared with a DC. However, TSA advocated a cautious interpretation of the results. Prospero Register ID CRD42021276557

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Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis

Cited by 18 publications

References 26 publications

Risk Factors for Postoperative Ileus after Diverting Loop Ileostomy Closure following Rectal Cancer Surgery: A Retrospective Study

Risk Factors for Postoperative Ileus after Diverting Loop Ileostomy Closure following Rectal Cancer Surgery: A Retrospective Study

Risk factors for postoperative ileus following loop ileostomy closure

Early versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a meta-analysis and trial sequential analysis of safety and functional outcomes

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