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Review
. 2024 May 8;39(1):68.
doi: 10.1007/s00384-024-04639-2.

Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

Shilai Yang  1 , Gang Tang  2 , Yudi Zhang  3 , Zhengqiang Wei  1 , Donglin Du  4
Affiliations
Review

Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

Shilai Yang et al. Int J Colorectal Dis. .

Abstract

Purpose: Anastomotic leakage is a serious complication of colorectal cancer surgery, prolonging hospital stays and impacting patient prognosis. Preventive colostomy is required in patients at risk of anastomotic fistulas. However, it remains unclear whether the commonly used loop colostomy(LC) or loop ileostomy(LI) can reduce the complications of colorectal surgery. This study aims to compare perioperative morbidities associated with LC and LI following anterior rectal cancer resection, including LC and LI reversal.

Methods: In this meta-analysis, the Embase, Web of Science, Scopus, PubMed, and Cochrane Library databases were searched for prospective cohort studies, retrospective cohort studies, and randomized controlled trials (RCTs) on perioperative morbidity during stoma development and reversal up to July 2023, The meta-analysis included 10 trials with 2036 individuals (2 RCTs and 8 cohorts).

Results: No significant differences in morbidity, mortality, or stoma-related issues were found between the LI and LC groups after anterior resection surgery. However, patients in the LC group exhibited higher rates of stoma prolapse (RR: 0.39; 95%CI: 0.19-0.82; P = 0.01), retraction (RR: 0.45; 95%CI: 0.29-0.71; P < 0.01), surgical site infection (RR: 0.52; 95%CI: 0.27-1.00; P = 0.05) and incisional hernias (RR: 0.53; 95%CI: 0.32-0.89; P = 0.02) after stoma closure compared to those in the LI group. Conversely, the LI group showed higher rates of dehydration or electrolyte imbalances(RR: 2.98; 95%CI: 1.51-5.89; P < 0.01), high-output(RR: 6.17; 95%CI: 1.24-30.64; P = 0.03), and renal insufficiency post-surgery(RR: 2.51; 95%CI: 1.01-6.27; P = 0.05).

Conclusion: Our study strongly recommends a preventive LI for anterior resection due to rectal cancer. However, ileostomy is more likely to result in dehydration, renal insufficiency, and intestinal obstruction. More multicenter RCTs are needed to corroborate this.

Keywords: Anastomotic leakage; Colorectal cancer; Loop colostomy; Loop ileostomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of literature search and screening
Fig. 2
Fig. 2
Risk of bias for each included RCT study. A Risk of bias summary. B Risk of bias graph
Fig. 3
Fig. 3
The morbidity (A), mortality (B) and stoma-related complication (C) in the stoma formation between LI and LC groups
Fig. 4
Fig. 4
The stoma prolapse (A), stoma retraction (B), stoma stricture (C), and stoma bleeding and edema (D) between LI and LC groups
Fig. 5
Fig. 5
The parastomal dermatitis (A), parastomal hernia (B), necrosis (C), parastomal infection & sepsis (D) between LI and LC groups
Fig. 6
Fig. 6
The Dehydration or Electrolyte disturbance (A), High-output (B) and renal insufficiency (C) between LI and LC groups
Fig. 7
Fig. 7
The morbidity (A), mortality (B),stoma closure related complication (C) and anastomotic fistula (D) after stoma closure between LI and LC groups
Fig. 8
Fig. 8
The Surgical site infections (A), Incisional hernia (B) and Ileus (C) after stoma closure between LI and LC groups
Fig. 9
Fig. 9
The Operation time (A), Time to first defecation (B) and Discharge (C) after stoma closure between LI and LC groups
Fig. 10
Fig. 10
The funnel plot of A parastomal hernia. B Surgical site infections rate
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. 10.3322/caac.21492 - PubMed
    1. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB (2019) Colorectal cancer. Lancet 394(10207):1467–1480. 10.1016/S0140-6736(19)32319-0 - PubMed
    1. Paschke S, Jafarov S, Staib L, Kreuser ED, Maulbecker-Armstrong C, Roitman M, Holm T, Harris CC, Link KH, Kornmann M (2018) Are colon and rectal cancer two different tumor entities? A proposal to abandon the term colorectal cancer. Int J Mol Sci 19(9):2577. 10.3390/ijms19092577 - PMC - PubMed
    1. Heald RJ (1979) A new approach to rectal cancer. Br J Hosp Med 22(3):277–281 - PubMed
    1. Kim NK, Lim DJ, Yun SH, Sohn SK, Min JS (2001) Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results. Int J Colorectal Dis 16(4):234–237. 10.1007/s003840100306 - PubMed