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

Hajibandeh, Shahin; Hajibandeh, Shahab; Sarma, Diwakar Ryali; East, Jamie; Zaman, Shafquat; Mankotia, Rajnish; Thompson, Christopher; Torrance, Andrew W.; Peravali, Rajeev

doi:10.1007/s00384-019-03321-2

Cited by 23 publications

(18 citation statements)

References 22 publications

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“…The reason why the higher rate of wound infection in low midline incision than low transverse incision in patients who underwent SESS in this study was postulated by the hypothesis that impaired blood supply to the low midline wound site combined with wound contamination during stoma closure may increase the likelihood of wound infection. In contrast to a recent meta-analysis [31], in which the wound infection rate was less than 10% following stoma closure in patients with rectal cancer, the wound infection rate of 31.5% after stoma closure in our 108 patients who underwent SESS seemed to be quite high. However, wound infection rate after stoma closure in cases of SESS in this study will be interpreted in consideration of the fact that the wound infection rate after stoma closure can reach 36% and may be higher than the usual report as mentioned in previous literature [32].…”

Section: A C C E P T E Dcontrasting

confidence: 97%

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Kim

Shin

2020

Ann Coloproctol

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Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions, and assessed whether wound complications of specimen extraction site (SES) are increased by specimen extraction through stoma site (SESS) in LRCS. Methods From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into two groups: midline (n=102) and transverse (n=87) groups, and perioperative outcomes were compared. Results The midline group showed higher the frequency of temporary stoma formation (p=0.001) and splenic flexure mobilization (p<0.001) than transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (p=0.494 and p=0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (p=0.840 and p=0.035, respectively). Conclusions In terms of incisional hernia and wound infection of SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS would be performed with caution in LRCS.

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Section: A C C E P T E Dcontrasting

confidence: 97%

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Kim

Shin

2020

Ann Coloproctol

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“…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). In our study, loop ileostomy was closed in eight patients within ≤2 months following the first surgery, and in 71 patients >2 months following the first surgery.…”

Section: Discussionmentioning

confidence: 55%

Risk factors for postoperative ileus following loop ileostomy closure

et al. 2020

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“…However, there are reports that both early (< 30 days) and late (> 6 months) stoma closure may be associated with an increased rate of postoperative complications [15,16]. Despite several reports of good functional and oncological results of stoma reversal during adjuvant chemotherapy, there have been no known results of randomised trials to date [17,18]. The occurrence of postoperative complications related to the closure of the stoma before or during adjuvant chemotherapy may be a reason to discontinue oncological treatment.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

et al. 2020

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Background: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. Methods: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. Results: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002-1.013, p = 0.013). Conclusions: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models.

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

Cited by 23 publications

References 22 publications

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Risk factors for postoperative ileus following loop ileostomy closure

Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

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