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

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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Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center

Gastroenterology Research and Practice ◽

10.1155/2021/5592721 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Zhen Sun ◽

Yufeng Zhao ◽

Lu Liu ◽

Jichao Qin

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Anterior Resection ◽

Low Anterior Resection ◽

Ileostomy Closure ◽

Cancer Resection ◽

Group Iii ◽

Rectal Cancer Resection ◽

Group I ◽

Temporary Ileostomy

Background. The optimal timing of temporary ileostomy closure with respect to the time of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer remains unclear. The aim of this study is to investigate the clinical and oncological outcomes of ileostomy closure before, during, and after adjuvant chemotherapy following curative rectal cancer resection. Methods. Patients diagnosed with rectal adenocarcinoma who underwent low anterior resection and temporary loop ileostomy during May 2015 and September 2019 were retrospectively evaluated. Patients undergoing ileostomy closure before adjuvant chemotherapy (Group I) were compared to patients undergoing closure during (Group II) and after (Group III) adjuvant chemotherapy. Results. A total of 225 patients were evaluated for eligibility, and 132 were finally selected and divided into 3 groups (24 in Group I, 53 in Group II, and 55 in Group III). No significant differences were observed in operative time, postoperative hospital stay, postoperative complications, total adjuvant chemotherapy cycles, and low anterior resection syndrome scores among the three groups. There was no significant difference in disease-free survival ( p = 0.834 ) and overall survival ( p = 0.462 ) between the three groups. Conclusion. Temporary ileostomy closure before adjuvant chemotherapy following curative rectal cancer resection can achieve a clinical and oncological safety level equal to stoma closure during or after chemotherapy in selected patients.

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Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis

Surgical Oncology ◽

10.1016/j.suronc.2021.101556 ◽

2021 ◽

pp. 101556

Author(s):

Hytham K.S. Hamid ◽

George N. Davis ◽

Mario Trejo-Avila ◽

Patrick O. Igwe ◽

Andrés Garcia-Marín

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Predictive Value ◽

Meta Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Cancer Resection ◽

Lymphocyte Ratio ◽

Rectal Cancer Resection

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

Journal of Surgical Oncology ◽

10.1002/jso.23493 ◽

2013 ◽

Vol 109 (3) ◽

pp. 266-269 ◽

Cited By ~ 13

Author(s):

Hagit Tulchinsky ◽

Einat Shacham-Shmueli ◽

Joseph M. Klausner ◽

Moshe Inbar ◽

Ravit Geva

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Loop Ileostomy ◽

Ileostomy Closure

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Does Preoperative Radio(chemo)therapy Increase Anastomotic Leakage in Rectal Cancer Surgery? A Meta-Analysis of Randomized Controlled Trials

Gastroenterology Research and Practice ◽

10.1155/2014/910956 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Changjiang Qin ◽

Xuequn Ren ◽

Kaiwu Xu ◽

Zhihui Chen ◽

Yulong He ◽

...

Keyword(s):

Rectal Cancer ◽

Randomized Controlled Trials ◽

Anastomotic Leakage ◽

Anastomotic Leak ◽

Preoperative Radiotherapy ◽

Meta Analysis ◽

Controlled Trials ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

Randomized Controlled

Objective. Preoperative radio(chemo)therapy (pR(C)T) appears to increase postoperative complications of rectal cancer resection, but clinical trials have reported conflicting results. The objective of this meta-analysis was performed to assess the effects of pR(C)T on anastomotic leak after rectal cancer resection.Methods. PubMed, Embase, and the Cochrane Library were searched from January 1980 to January 2014. Randomized controlled trials included all original articles reporting anastomotic leak in patients with rectal cancer, among whom some received preoperative radiotherapy or chemoradiotherapy while others did not. The analysed end-points were the anastomotic leak.Result. Seven randomized controlled trials with 3375 patients were included in the meta-analysis. 1660 forming the group undergoing preoperative radiotherapy or chemoradiotherapy versus 1715 patients undergoing without preoperative radiotherapy or chemoradiotherapy. The meta-analyses found that pR(C)T was not an independent risk factor for anastomotic leakage (OR 1.02, 95% CI 0.80–1.30;P=0.88). Subgroups analysis was performed and the result was not altered.Conclusions. Current evidence demonstrates that pR(C)T did not increase the risk of postoperative anastomotic leak after rectal cancer resection in patients.

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