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Review
. 2021 Mar;36(3):445-455.
doi: 10.1007/s00384-020-03771-z. Epub 2020 Oct 16.

A meta-analysis of the role of diverting ileostomy after rectal cancer surgery

Nasir Zaheer Ahmad  1 , Muhammad Hasan Abbas  2 , Saad Ullah Khan  2 , Amjad Parvaiz  3   4
Affiliations
Review

A meta-analysis of the role of diverting ileostomy after rectal cancer surgery

Nasir Zaheer Ahmad et al. Int J Colorectal Dis. 2021 Mar.

Abstract

Purpose: Anastomotic leak is a feared complication of rectal cancer surgery. A diverting stoma is believed to act as a safety mechanism against this undesirable outcome. This meta-analysis aimed to examine the role of loop ileostomy in the prevention of this complication.

Methods: The Medline, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) comparing anastomotic complications after rectal cancer surgery in the presence or absence of diverting ileostomy. The need for reoperation and postoperative complications were also analysed. The length of hospital stay, intraoperative blood loss and operating time were analysed as secondary endpoints.

Results: A significantly higher number of anastomotic leaks was detected in patients with no diverting ileostomies than in those with diversion (odds ratio (OR) 0.292 and 95% confidence interval (CI) 0.177-0.481), and more patients required reoperations in this group (OR 0.219 and 95% CI 0.114-0.422). The rate of complications other than anastomotic leak was significantly higher in patients with diverting ileostomies than in those without (OR 3.337 and 95% CI of 1.570-7.093). The operating time was longer in the ileostomy group than in the no ileostomy group (P 0.001), but no significant differences in the intraoperative blood loss or postoperative hospital stay length were observed between the two groups(P 0.199 and 0.191 respectively).

Conclusion: A lower leak rate in the presence of diverting ileostomy is supported by relatively weak evidence. While mitigating the consequences of leakage, diverting ileostomies lead to numerous other complications. High-quality RCTs are needed before routine ileostomy diversions can be recommended after rectal cancer surgery.

Keywords: Anastomotic leak; Anterior resection; Diverting ileostomy; Rectal cancer.

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References

    1. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 69:613–616 - DOI
    1. Karanjia ND, Corder AP, Bearn P, Heald RJ (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226 - DOI
    1. Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, Paty P, Minsky B, Weyrauch K, Quan SHQ (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230:544–552 discussion 552-4 - DOI
    1. Hüser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60 - DOI
    1. Gavriilidis P, Azoulay D, Taflampas P (2019) Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis. Surg Today 49:108–117 - DOI

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