Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

作者全名：Yang, Shilai; Tang, Gang; Zhang, Yudi; Wei, Zhengqiang; Du, Donglin

作者地址：[Yang, Shilai; Wei, Zhengqiang; Du, Donglin] Chongqing Med Univ, Dept Gastrointestinal Surg, Affiliated Hosp 1, Chongqing, Peoples R China; [Tang, Gang] Sichuan Univ, West China Hosp, Dept Gen Surg, Div Biliary Tract Surg, Chengdu, Sichuan, Peoples R China; [Zhang, Yudi] Chongqing Coll Tradit Chinese Med, Coll Combinat Chinese & Western Med, 61 Puguobao Rd,Bicheng St, Chongqing 402760, Peoples R China

通信作者：Du, DL (通讯作者)，Chongqing Med Univ, Dept Gastrointestinal Surg, Affiliated Hosp 1, Chongqing, Peoples R China.

来源：INTERNATIONAL JOURNAL OF COLORECTAL DISEASE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001215646000001

JCR分区：Q1

影响因子：2.5

年份：2024

卷号：39

期号：1

开始页：　

结束页：　

文献类型：Review

关键词：Loop colostomy; Loop ileostomy; Anastomotic leakage; Colorectal cancer

摘要：Purpose Anastomotic leakage is a serious complication of colorectal cancer surgery, prolonging hospital stays and impacting patient prognosis. Preventive colostomy is required in patients at risk of anastomotic fistulas. However, it remains unclear whether the commonly used loop colostomy(LC) or loop ileostomy(LI) can reduce the complications of colorectal surgery. This study aims to compare perioperative morbidities associated with LC and LI following anterior rectal cancer resection, including LC and LI reversal. Methods In this meta-analysis, the Embase, Web of Science, Scopus, PubMed, and Cochrane Library databases were searched for prospective cohort studies, retrospective cohort studies, and randomized controlled trials (RCTs) on perioperative morbidity during stoma development and reversal up to July 2023, The meta-analysis included 10 trials with 2036 individuals (2 RCTs and 8 cohorts). Results No significant differences in morbidity, mortality, or stoma-related issues were found between the LI and LC groups after anterior resection surgery. However, patients in the LC group exhibited higher rates of stoma prolapse (RR: 0.39; 95%CI: 0.19-0.82; P = 0.01), retraction (RR: 0.45; 95%CI: 0.29-0.71; P < 0.01), surgical site infection (RR: 0.52; 95%CI: 0.27-1.00; P = 0.05) and incisional hernias (RR: 0.53; 95%CI: 0.32-0.89; P = 0.02) after stoma closure compared to those in the LI group. Conversely, the LI group showed higher rates of dehydration or electrolyte imbalances(RR: 2.98; 95%CI: 1.51-5.89; P < 0.01), high-output(RR: 6.17; 95%CI: 1.24-30.64; P = 0.03), and renal insufficiency post-surgery(RR: 2.51; 95%CI: 1.01-6.27; P = 0.05). Conclusion Our study strongly recommends a preventive LI for anterior resection due to rectal cancer. However, ileostomy is more likely to result in dehydration, renal insufficiency, and intestinal obstruction. More multicenter RCTs are needed to corroborate this.

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