Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis
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Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta‑analysis Li Wang1,2,3 · Xinling Chen2,3 · Chen Liao2,3 · Qian Wu2,3 · Hongliang Luo2 · Fengming Yi2,4 · Yiping Wei1 · Wenxiong Zhang1 Received: 14 May 2020 / Accepted: 7 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract The complications caused by early closure (EC) or late closure (LC) after temporary ileostomy in rectal cancer patients have not been compared systematically. We conducted this meta-analysis to explore the details surrounding this issue, based on a search of PubMed, ScienceDirect, Scopus, Web of Science, Ovid MEDLINE, the Cochrane Library, Embase, and Google Scholar. The comparative indices included total complications, severe complications, and various individual complications before or after closure. Four randomized-controlled trials (RCTs), including the EASY trial, were analyzed, involving a collective total of 324 patients. EC tended to result in more postoperative complications than LC for rectal cancer patients with temporary ileostomy. This difference was mainly embodied in wound complications. Nevertheless, LC resulted in more complications than EC before closure, such as leakage outside the appliance bag and skin irritation. There was no obvious difference in severe postoperative complications or medical complications. With fewer overall and wound-related complications, LC tended to be more suitable than EC for rectal cancer patients with a temporary ileostomy; however, the complications before closure should also be considered. Keywords Rectal cancer · Temporary ileostomy · Early closure · Late closure · Meta-analysis Abbreviations CI Confidence interval PRISMA Preferred Reporting Items for Systematic Review and Meta-Analysis HR Hazard ratios RR Risk ratios RCT Randomized-controlled trial Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02115-2) contains supplementary material, which is available to authorized users. * Wenxiong Zhang [email protected] 1
Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang 330006, China
2
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
3
Jiangxi Medical College, Nanchang University, Nanchang 330006, China
4
Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
EC Early closure LC Late closure GRADE Grading of Recommendations Assessment, Development and Evaluation
Introduction Rectal cancer is reported to be the fourth- and third-most common tumor in men and women, respectively [1, 2]. Low anterior resection has long been accepted as a potentially curable surgical option for rectal cancer [3]. Because of the low anastomosis close to the pelvic floor, diverting ileostomy is often performed to minimize the risk of anastomotic complications, such as leakage and reoperation, after rectal e
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