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. 2018 Apr 17;9(29):20816-20825.
doi: 10.18632/oncotarget.25015.

Defunctioning ileostomy reduces leakage rate in rectal cancer surgery - systematic review and meta-analysis

Magdalena Pisarska  1   2 , Natalia Gajewska  1 , Piotr Małczak  1   2 , Michał Wysocki  1   2 , Jan Witowski  1   2 , Grzegorz Torbicz  1 , Piotr Major  1   2 , Magdalena Mizera  1 , Marcin Dembiński  1 , Marcin Migaczewski  1 , Andrzej Budzyński  1   2 , Michał Pędziwiatr  1   2
Affiliations

Defunctioning ileostomy reduces leakage rate in rectal cancer surgery - systematic review and meta-analysis

Magdalena Pisarska et al. Oncotarget. .

Abstract

Objectives: The role of a defunctioning ileostomy in every anterior rectal resection with total mesorectal excision (TME) is still controversial. In this study, we aimed to review the current literature to determine the impact of ileostomy creation on postoperative outcomes in patients undergoing anterior rectal resection with TME.

Methods: MEDLINE, Embase and Cochrane Library were searched for eligible studies. We analyzed data up to October 2017. Eligible studies had to compare patients with vs. without a defunctioning ileostomy in rectal cancer surgery and comprise data on anastomotic leakage in both groups. The primary outcome was anastomotic leakage. Secondary outcomes included the complication rate, mortality, reoperation rate, length of hospital stay and 30-day readmission.

Results: Initial search yielded 1,966 articles. Thorough evaluation resulted in 13 eligible articles which were analyzed. Leakage rate (RR = 0.43, 95% CI 0.28-0.67) and the number of reoperations (RR = 0.62, 95% CI 0.40-0.94) were significantly lower in the defunctioning stoma group. Morbidity was significantly higher in the stoma group (RR = 1.32, 95% CI 1.05-1.65). Analysis of mortality, length of hospital stay and readmission rate did not show any significant differences.

Conclusion: A defunctioning ileostomy may decrease the anastomotic leakage rate, additionally significantly reducing the risk of reoperations but it may also increase the overall complication rate. The presence of the protective stoma has no effect on mortality, length of hospital stay and readmission rate.

Keywords: defunctioning ileostomy; leakage; meta-analysis; rectal cancer.

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Conflict of interest statement

CONFLICTS OF INTEREST The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flowchart
Figure 2
Figure 2. Funnel plot
Figure 3
Figure 3. Pooled estimates of anastomotic leakage after rectal resection with versus without defunctioning ileostomy
Figure 4
Figure 4. Pooled estimates of complication rate after rectal resection with versus without defunctioning ileostomy
Figure 5
Figure 5. Pooled estimates of mortality after rectal resection with versus without defunctioning ileostomy
Figure 6
Figure 6. Pooled estimates of reoperations after rectal resection with versus without defunctioning ileostomy
Figure 7
Figure 7. Pooled estimates of length of hospital stay comparing rectal resection with versus without defunctioning ileostomy
Figure 8
Figure 8. Pooled estimates of readmission rate after rectal resection with versus without defunctioning ileostomy
See this image and copyright information in PMC

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