Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy?

Abstract Aims 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-effect 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 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 closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

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

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03321-2 ◽

2019 ◽

Vol 34 (7) ◽

pp. 1151-1159 ◽

Cited By ~ 2

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Diwakar Ryali Sarma ◽

Jamie East ◽

Shafquat Zaman ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Meta Analysis ◽

Loop Ileostomy ◽

Ileostomy Closure ◽

Cancer Resection ◽

Rectal Cancer Resection

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Utility of EUS to identify the effective responders from rectal cancer patients who receive neo-adjuvant chemotherapy

Endoscopy ◽

10.1055/s-0031-1292223 ◽

2011 ◽

Vol 43 (S 03) ◽

Author(s):

Zhang Xiaoyin ◽

Guo Xuegang ◽

Wang Xin ◽

Du Jianjun ◽

Zhao Qingchuan ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Neo Adjuvant Chemotherapy

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Patient Risk Subgroups Predict Benefit of Adjuvant Chemotherapy in Stage II Rectal Cancer Patients Following Neoadjuvant Chemoradiation and Total Mesorectal Excision

Clinical Colorectal Cancer ◽

10.1016/j.clcc.2021.02.006 ◽

2021 ◽

Author(s):

Samer Naffouje ◽

Arvind Sabesan ◽

Benjamin D. Powers ◽

Sophie Dessureault ◽

Julian Sanchez ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Total Mesorectal Excision ◽

Cancer Patients ◽

Neoadjuvant Chemoradiation ◽

Stage Ii ◽

Mesorectal Excision ◽

Patient Risk

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Mecobalamin as a Neuroprotective Effector against Oxaliplatin-Based Chemotherapy in Colon and Rectal Cancer Patients

Care Weekly ◽

10.14283/cw.2021.2 ◽

2021 ◽

pp. 1-5

Author(s):

Li Hongyan ◽

Lu Wanting ◽

Li Fei

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Disease Free Survival ◽

Sensory Neuropathy ◽

Control Group ◽

Placebo Control ◽

Case Group ◽

Colon And Rectal Cancer ◽

Grade 3

Palliative chemotherapy prolongs survival and improves quality of life. However, a variety of chemotherapeutics including oxaliplatin can cause severe side effects during treatments, leading to painful symptoms that might result in the interruption of cancer treatment. Although adding oxaliplatin to fluorouracil and leucovorin in adjuvant chemotherapy for colon and rectal cancer may improve disease-free survival, it also increases grade 3–4 sensory neuropathy. Our study aimed to determine whether oral Mecobalamin is neuroprotective against oxaliplatin-induced neuropathy. Forty-six stage III colon and rectal cancer patients receiving adjuvant biweekly oxaliplatin were randomized to oral Mecobalamin (1,500 mg; case group) or placebo (control group). Clinical neurological and electrophysiological evaluations were performed at baseline and after 4, 8, and 12 treatment cycles. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) criteria. After four cycles of chemotherapy, 9 of 23 patients in the control group and 8 of 23 patients in case group experienced grade 1 sensory neuropathy. After eight cycles, 13 patients experienced sensory neuropathy (grade 2–4 toxicity) in the control group; however, no patients in the case group experienced sensory neuropathy (P < 0.05). After 12 cycles, grade 2–4 sensory neuropathy was observed in 20 patients in the control group, but only in 4 patients in the case group (P < 0.05). We did not observe any significant electrophysiological changes in the case group after 4, 8, or 12 cycles of chemotherapy. Thus, we demonstrated that oral Mecobalamin reduces the incidence of neuropathy in colon and rectal cancer patients receiving oxaliplatin-based adjuvant chemotherapy.

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