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

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.