Risk and consequences of dehydration following colorectal cancer resection with diverting ileostomy. A systematic review and meta‐analysis

Abstract

Aim: This systematic review aims to assess dehydration prevalence and dehydrationrelated morbidity from diverting ileostomy compared to resections without ileostomy formation in adults undergoing colorectal resection for cancer.Method: MEDLINE, Embase, CENTRAL and ClinicalTrials.gov were searched for studies of any design that reported dehydration, renal function and dehydration-related morbidity in adult colorectal cancer patients with diverting ileostomy (last search 12 August 2020). Bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized trials and the Risk of Bias in Non-randomized Studies of Interventions tool.Results: Of 1927 screened papers, 22 studies were included (21 cohort studies and one randomized trial) with a total of 19 485 patients (12 209 with ileostomy). The prevalence of dehydration was 9.00% (95% CI 5.31-13.45, P < 0.001). The relative risk of dehydration following diverting ileostomy was 3.37 (95% CI 2.30-4.95, P < 0.001). Three studies assessing long-term trends in renal function demonstrated progressive renal impairment persisting beyond the initial insult. Consequences identified included unplanned readmission, delay or non-commencement of adjuvant chemotherapy, and development of chronic kidney disease.Discussion: Significant dehydration is common following diverting ileostomy; it is linked to acute kidney injury and has a long-term impact on renal function. This study suggests that ileostomy confers significant morbidity particularly related to dehydration and renal impairment.

Acute kidney injury prevalence in patients with colorectal cancer undergoing surgery with curative intent

“…In our study patients with prior radiotherapy did not develop AKI, while among subjects with prior radiochemotherapy 11% developed AKI. In a recent review, Borucki et al [26] reported that significant dehydration was common following ileostomy and was linked with AKI and had a long-term impact on renal function.…”

Protective ileostomy creation after anterior resection of the rectum: Shared decision‐making or still subjective?

“…Moreover, PI creation is itself responsible for morbidity, including intestinal atrophy, leakage from the stoma appliance, skin irritation, bowel obstruction, enterocutaneous fistula, high-output stoma, renal impairment, parastomal hernia or prolapse and hospital readmission, so in the case of patients without AL its utility should be balanced with its complications [36,[39][40][41][42].…”

“…Lastly, independently from the indication to create a PI, it is important to underline that in the literature the real utility and advantages of a stoma are still under debate [28][29][30][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

“…Finally, about 28% of PIs become permanent due to anastomotic complications, the need for adjuvant chemotherapy or oncological disease progression [36,39,51,52]. For these reasons, many efforts have been made to study this condition [28][29][30][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52].…”

Acute kidney injury is a common and significant complication following ileostomy formation

“…Since the Cr at discharge has normalized in rate of readmission for dehydration or renal failure was 17%, and that 55% of these patients (18/33) had a concomitant AKI using the Acute Kidney Injury Network criteria [7]. A recent meta-analysis has linked ileostomies to long-term renal dysfunction and cites a casecontrol analysis of 101 patients, 18% of whom were on surgical services, to support the claim that dehydration causes these renal issues [16]. The claim that dehydration alone causes long-term renal dysfunction is challenged by the finding of Fish et al demonstrating that outpatient intravenous fluid administration did not prevent readmissions [2].…”