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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 7/2019

01-07-2019 | Rectal Cancer | Review

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

Authors: Shahin Hajibandeh, Shahab Hajibandeh, Diwakar Ryali Sarma, Jamie East, Shafquat Zaman, Rajnish Mankotia, Christopher Vaun Thompson, Andrew W Torrance, Rajeev Peravali

Published in: International Journal of Colorectal Disease | Issue 7/2019

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Abstract

Objective

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 effects 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 the 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 the closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on the completeness of chemotherapy and quality of life which can determine the appropriateness of either approach.
Appendix
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Metadata
Title
Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: the dilemma remains
Authors
Shahin Hajibandeh
Shahab Hajibandeh
Diwakar Ryali Sarma
Jamie East
Shafquat Zaman
Rajnish Mankotia
Christopher Vaun Thompson
Andrew W Torrance
Rajeev Peravali
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 7/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03321-2

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