A meta-analysis of the role of diverting ileostomy after rectal cancer surgery
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REVIEW
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 Accepted: 8 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 . Rectal cancer . Diverting ileostomy
Introduction * Nasir Zaheer Ahmad [email protected] Muhammad Hasan Abbas [email protected] Saad Ullah Khan [email protected] Amjad Parvaiz [email protected] 1
Department of Surgery, University Hospital Limerick, St Nessan’s Rd, Dooradoyle, Co, Limerick V94 F858, Republic of Ireland
2
Department of Surgery, Russells Hall Hospital NHS Trust, Pensnett Rd, West Midlands, Dudley DY1 2HQ, UK
3
Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK
4
Colorectal Department, Poole NHS Trust, Poole, UK
The oncological outcomes of rectal cancer surgery have changed since the advent of total mesorectal excision (TME), which was first described by Richard Heald [1], and the incidence of local disease recurrence has significant decreased. However, the incidence rates of postoperative surgical complications, especially anastomotic leak, remain almost unchanged. Anastomotic leak is the most feared complication after local recurrence
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