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Meta-Analysis
. 2025 Jul 1;25(1):491.
doi: 10.1186/s12876-025-04090-9.

Post-surgical morbidity in early versus late closure of defunctioning ileostomy after rectal cancer surgery: A systematic review and meta-analysis of randomised controlled trials

Dedrick Kok Hong Chan  1 , Jerrald Lau  2   3 , Jarrod Kah-Hwee Tan  4 , Bryan Jun Liang Buan  4 , Kai-Yin Lee  4 , Norman Sihan Lin  4 , Ian Jse-Wei Tan  4 , Jing-Yu Ng  4 , Bettina Lieske  4 , Wai-Kit Cheong  4 , Ker-Kan Tan  4
Affiliations
Meta-Analysis

Post-surgical morbidity in early versus late closure of defunctioning ileostomy after rectal cancer surgery: A systematic review and meta-analysis of randomised controlled trials

Dedrick Kok Hong Chan et al. BMC Gastroenterol. .

Abstract

Background: A defunctioning ileostomy is frequently created to avert the implications of a colo-rectal anastomotic dehiscence in rectal cancer surgery. The timing of closure of the ileostomy remains debatable as it is believed that early closure (EC) may be beneficial to most patients than the standard practice of late closure (LC). This meta-analysis was performed to compare surgical outcomes in patients who underwent EC versus LC.

Methods: Randomised controlled trials (RCT) which evaluated the effect of EC versus LC of ileostomy on surgical outcomes in rectal cancer patients was searched on PubMed, Web of Science, Embase and Cochrane Library. RCTs evaluating EC vs. LC of defunctioning ileostomies for rectal cancer patients were included. The primary outcome measures include overall morbidity, surgical complications, anastomotic dehiscence, and reoperation rates.

Results: Five RCTs were included in this meta-analysis of 387 patients. The pooled estimate of the OR for overall morbidity (OR 1.80, 95% CI 0.97-3.31; p = 0.06), reoperation (OR 2.57, 95% CI 0.72-9.14; p = 0.14), and anastomotic leakage (OR 3.25, 95% CI 0.40-26.38; p = 0.27) were not statistically significant. EC however resulted in a statistically significant increase in terms of surgical complications (OR 2.63, 95% CI 1.04-6.67; p = 0.04). These studies had low to moderate levels of statistical heterogeneity.

Conclusion: EC of defunctioning ileostomy in rectal cancer patients results in increased surgical complications compared to patients with LC. Caution must be undertaken in patients in whom an EC is performed.

Keywords: Early closure; Ileostomy; Meta-analysis; Morbidity; Rectal cancer.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA chart illustrating the search strategy, excluded records and records included in the quantitative analysis
Fig. 2
Fig. 2
Cochrane risk of bias tool for quality assessment in randomized controlled trials
Fig. 3
Fig. 3
Forest plot comparing overall morbidity rate between EC and LC
Fig. 4
Fig. 4
Forest plot comparing post-operative surgical complications between EC and LC
Fig. 5
Fig. 5
Forest plot comparing anastomotic leak rates from ileostomy reversal between EC and LC
Fig. 6
Fig. 6
Forest plot comparing re-operation rates between EC And LC
Fig. 7
Fig. 7
Forest plot comparing duration of surgery between EC and LC
Fig. 8
Fig. 8
Forest plot comparing length of stay between EC and LC
Fig. 9
Fig. 9
Forest plot comparing time to flatus between EC And LC
Fig. 10
Fig. 10
Forest plot comparing time to diet between EC and LC
Fig. 11
Fig. 11
Funnel plot for overall morbidity in the assessment of publication bias
See this image and copyright information in PMC

References

    1. Gastinger I, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92(9):1137–42. - PubMed
    1. Lordan JT, et al. Following anterior resection for rectal cancer, defunctioning ileostomy closure May be significantly delayed by adjuvant chemotherapy: a retrospective study. Colorectal Dis. 2007;9(5):420–2. - PubMed
    1. David GG, et al. Loop ileostomy following anterior resection: is it really temporary? Colorectal Dis. 2010;12(5):428–32. - PubMed
    1. Pan HD, et al. Risk factors for nonclosure of a temporary defunctioning ileostomy following anterior resection of rectal Cancer. Dis Colon Rectum. 2016;59(2):94–100. - PubMed
    1. Chan DKH, et al. Journey for patients following ileostomy creation is not straightforward. Int J Colorectal Dis. 2019;34(12):2075–80. - PubMed

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