Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: the dilemma remains
| Autor: | Rajeev Peravali, Andrew W. Torrance, Christopher Vaun Thompson, Shahin Hajibandeh, Diwakar R Sarma, Rajnish Mankotia, Jamie East, Shafquat Zaman, Shahab Hajibandeh |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Ileus Colorectal cancer medicine.medical_treatment Anastomotic Leak Anastomosis 03 medical and health sciences Ileostomy Postoperative Complications 0302 clinical medicine Quality of life medicine Humans Surgical Wound Infection Aged Rectal Neoplasms business.industry Gastroenterology Perioperative Length of Stay Middle Aged medicine.disease Surgery Clinical trial Chemotherapy Adjuvant 030220 oncology & carcinogenesis Meta-analysis 030211 gastroenterology & hepatology business |
| Zdroj: | International Journal of Colorectal Disease. 34:1151-1159 |
| ISSN: | 1432-1262 0179-1958 |
| DOI: | 10.1007/s00384-019-03321-2 |
| Popis: | To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. 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. 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. 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. |
| Databáze: | OpenAIRE |
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