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Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis

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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.

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Abbreviations

CI:

Confidence interval

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-Analysis

HR:

Hazard ratios

RR:

Risk ratios

RCT:

Randomized-controlled trial

EC:

Early closure

LC:

Late closure

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

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Acknowledgements

We thank professor Jichun Liu, of The Department of Cardio-Thoracic Surgery, The second affiliated hospital of Nanchang University, for his advice; and Professor Xiaoshu Cheng, of the Department of Cardiology, The second affiliated hospital of Nanchang University) for data collection.

Funding

This study was supported by The National Natural Science Foundation of China (NSFC) (Grant number: 81560345), and The Natural Science Foundation of Jiangxi Province (Grant number: 20181BAB215027). The funding had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, China

    Li Wang, Yiping Wei & Wenxiong Zhang

  2. Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China

    Li Wang, Xinling Chen, Chen Liao, Qian Wu, Hongliang Luo & Fengming Yi

  3. Jiangxi Medical College, Nanchang University, Nanchang, 330006, China

    Li Wang, Xinling Chen, Chen Liao & Qian Wu

  4. Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China

    Fengming Yi

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  1. Li Wang
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Contributions

LW had full access to all of the data in the manuscript, and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: all authors. Acquisition, analysis, or interpretation of data: all authors. LW and WZ: Drafting of the manuscript. LW, XC, CL, QW, HL, and FY: Critical revision of the manuscript for important intellectual content. LW, XC, CL, and QW: Statistical analysis. WZ: Supervision.

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Correspondence to Wenxiong Zhang.

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Supplementary file1 (DOC 66 kb)

Supplementary file2 (DOCX 18 kb)

Supplementary file3 (DOCX 20 kb)

595_2020_2115_MOESM4_ESM.tif

Supplementary file4 Fig. S1 Cochrane risk assessment associated with early vs late closure of temporary ileostomy after rectal cancer surgery. (TIF 7193 kb)

595_2020_2115_MOESM5_ESM.tif

Supplementary file5 Fig. S2 Sensitivity analysis of total complications (A), severe complications (B), leakage (C), and bowel obstruction (D) associated with early vs late closure of temporary ileostomy after rectal cancer surgery. (TIF 3604 kb)

595_2020_2115_MOESM6_ESM.tif

Supplementary file6 Fig. S3 Publication bias of total complications (A), severe complications (B), leakage (C), and bowel obstruction (D) associated with early vs late closure of temporary ileostomy after rectal cancer surgery. (TIF 1246 kb)

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Wang, L., Chen, X., Liao, C. et al. Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis. Surg Today 51, 463–471 (2021). https://doi.org/10.1007/s00595-020-02115-2

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  • DOI: https://doi.org/10.1007/s00595-020-02115-2

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