The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

Abstract

Background Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery. Methods Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale. Results We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I2 = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups. Conclusion The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

Clinical effects of prophylactic transverse colostomy in patients undergoing completely laparoscopic transabdominal approach partial intersphincteric resection

“…The results showed that prophylactic transverse colostomy based on CLAPISR could reduce the incidence of anastomotic leakage by 17% and play a beneficial role in prevention and protection, which is consistent with the results of a meta-analysis in 2021. 28 We believe that prophylactic transverse colostomy has the function of diversion, which can avoid large amounts of feces and bacteria from gathering near the anastomosis, relieve the pressure in the intestine, facilitate healing of the anastomosis, and reduce the occurrence of anastomotic leakage. Analysis of the complications in Group A revealed one grade A anastomotic leakage and one anastomotic stricture, which were cured by conservative treatment and postoperative anal dilatation, respectively.…”

The Correlation between the Use of the Proton Pump Inhibitor and the Clinical Efficacy of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer

“…The literature included in the study were retrospective studies and the quality evaluation of research referred to the Newcastle—Ottawa Quality Assessment Scale (NOS) [ 16 ]. The evaluation was scored with respect to three aspects, selection of topic, comparability, and evaluation of results.…”

Satisfactory short-term outcomes of totally laparoscopic ileostomy reversal compared to open surgery in colorectal cancer patients

“…In order to protect the downstream anastomoses and avoid anastomotic leakage, loop ileostomy is frequently used in colorectal cancer surgery (1). However, loop ileostomy often leads to a plethora of postoperative complications, decline of quality of life and some psychological problems (2, 3).…”