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The Effect of Intraoperative Rectal Washout on Local Recurrence after Rectal Cancer Surgery: A Meta-Analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Implantation of exfoliated cancer cells has been suggested as a possible mechanism of local recurrence at the site of colorectal anastomosis. Intraoperative rectal washout has been suggested to eliminate free cancer cells; however, there is no conclusive evidence of a beneficial effect of intraoperative rectal washout on local recurrence after anterior resection of rectal cancer.

Methods

Studies published through February 2012 evaluating the impact of intraoperative rectal washout for local recurrence or positive cytology from donuts wash were identified by an electronic literature search. A meta-analysis was performed using the DerSimonian-Laird random-effects models to compute risk ratio (RR) along with 95 % confidence intervals (CI).

Results

Nine studies met the inclusion criteria, yielding a total of 5,395 patients. Eight studies evaluated overall local recurrence, including anastomotic recurrence, and five of the eight studies evaluated anastomotic recurrence separately. Two studies evaluated positive cytology from donuts wash. Local recurrence rate was 5.79 % in the washout group and 10.05 % in the no washout group—a difference that was statistically significant (RR = 0.57; 95 % CI = 0.46-0.71; P < 0.00001). Rectal washout significantly reduced the risk of anastomotic recurrence (RR = 0.3; 95 % CI = 0.12-0.71; P = 0.007). No influence of rectal washout was observed on positive cytology from donuts wash.

Conclusions

From the results of this meta-analysis, it may be justified to recommend intraoperative rectal washout to prevent local recurrence in rectal cancer surgery.

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Acknowledgment

The authors thank the surgical staff at the Department of Surgery, Nippon Medical School Chiba-Hokuso Hospital for acquisition of data.

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Authors and Affiliations

  1. Department of Surgery, Nippon Medical School Chiba-Hokuso Hospital, Inzai, Chiba, Japan

    Akihisa Matsuda MD & Kimiyoshi Yokoi MD

  2. Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA

    Taro Kishi MD & Giovanna Musso PhD

  3. Department of Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan

    Takeshi Matsutani MD & Eiji Uchida MD

  4. Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA

    Ping Wang MD

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  1. Akihisa Matsuda MD
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  2. Taro Kishi MD
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  4. Takeshi Matsutani MD
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  5. Kimiyoshi Yokoi MD
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Correspondence to Akihisa Matsuda MD.

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Supplementary Table 1: Excluded studies at the process of full-text review. (PDF 26 kb)

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Matsuda, A., Kishi, T., Musso, G. et al. The Effect of Intraoperative Rectal Washout on Local Recurrence after Rectal Cancer Surgery: A Meta-Analysis. Ann Surg Oncol 20, 856–863 (2013). https://doi.org/10.1245/s10434-012-2660-4

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  • DOI: https://doi.org/10.1245/s10434-012-2660-4

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