Defunctioning ileostomy reduces leakage rate in rectal cancer surgery - systematic review and meta-analysis
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Magdalena Pisarska1,2, Natalia Gajewska1, Piotr Małczak1,2, Michał Wysocki1,2, Jan Witowski1,2, Grzegorz Torbicz1, Piotr Major1,2, Magdalena Mizera1, Marcin Dembiński1, Marcin Migaczewski1, Andrzej Budzyński1,2 and Michał Pędziwiatr1,2
12nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
2Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
Michał Pędziwiatr, email: firstname.lastname@example.org
Keywords: defunctioning ileostomy; leakage; rectal cancer; meta-analysis
Received: October 20, 2017 Accepted: March 08, 2018 Published: April 17, 2018
Objectives: The role of a defunctioning ileostomy in every anterior rectal resection with total mesorectal excision (TME) is still controversial. In this study, we aimed to review the current literature to determine the impact of ileostomy creation on postoperative outcomes in patients undergoing anterior rectal resection with TME.
Methods: MEDLINE, Embase and Cochrane Library were searched for eligible studies. We analyzed data up to October 2017. Eligible studies had to compare patients with vs. without a defunctioning ileostomy in rectal cancer surgery and comprise data on anastomotic leakage in both groups. The primary outcome was anastomotic leakage. Secondary outcomes included the complication rate, mortality, reoperation rate, length of hospital stay and 30-day readmission.
Results: Initial search yielded 1,966 articles. Thorough evaluation resulted in 13 eligible articles which were analyzed. Leakage rate (RR = 0.43, 95% CI 0.28-0.67) and the number of reoperations (RR = 0.62, 95% CI 0.40-0.94) were significantly lower in the defunctioning stoma group. Morbidity was significantly higher in the stoma group (RR = 1.32, 95% CI 1.05–1.65). Analysis of mortality, length of hospital stay and readmission rate did not show any significant differences.
Conclusion: A defunctioning ileostomy may decrease the anastomotic leakage rate, additionally significantly reducing the risk of reoperations but it may also increase the overall complication rate. The presence of the protective stoma has no effect on mortality, length of hospital stay and readmission rate.
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