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The influence of intraoperative rectal washout on local recurrence of colorectal cancer following curative resection: a systematic review and meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To determine the effectiveness of rectal washout in preventing local recurrence of distal colorectal cancer following curative resection.

Methods

A systematic review and meta-analysis was performed after a literature search was conducted on MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the ISRCTN registry. The study was reported using PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after distal colonic and rectal cancer surgery.

Results

After screening, 8 studies with a total sample size of 6739 patients were identified. At 5-year follow-up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51–0.78, Chi2 = 6.76, df = 7, p = 0.45). The relative risk reduction was 36.9%. To exclude a 36.9% relative risk reduction from 9.48 to 6.08% with a 5% significance level and 80% power a randomized control trial would require a total sample size of 1946 participants distributed equally between the two treatment arms.

Conclusion

It is safe to recommend the use of rectal washout for left sided and rectal tumour resections. It is a simple and safe step during colorectal surgery that appears to improve long-term oncological outcomes and was not reported to be associated with any complications.

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Data availability

On written request.

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  1. Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK

    Josh Solomon, Talal Majeed, Conor Magee & Jeremy Wilson

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  1. Josh Solomon
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Correspondence to Josh Solomon.

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Solomon, J., Majeed, T., Magee, C. et al. The influence of intraoperative rectal washout on local recurrence of colorectal cancer following curative resection: a systematic review and meta-analysis. Int J Colorectal Dis 37, 403–409 (2022). https://doi.org/10.1007/s00384-021-04071-w

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