Early vs. standard reversal ileostomy: a systematic review and meta-analysis.
Ileostomy reversal
Morbidity
Quality of life
Surgical outcomes
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
23
01
2022
accepted:
24
04
2022
pubmed:
22
5
2022
medline:
1
10
2022
entrez:
21
5
2022
Statut:
ppublish
Résumé
Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes. A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life. Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains. Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.
Sections du résumé
BACKGROUND
Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes.
METHODS
A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life.
RESULTS
Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains.
CONCLUSIONS
Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.
Identifiants
pubmed: 35596904
doi: 10.1007/s10151-022-02629-6
pii: 10.1007/s10151-022-02629-6
pmc: PMC9123394
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
851-862Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. Springer Nature Switzerland AG.
Références
Anderin K et al (2016) The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer. Eur J Surg Oncol 42(6):788–793
doi: 10.1016/j.ejso.2016.04.001
Fukudome I et al (2021) The safety of early versus late ileostomy reversal after low anterior rectal resection: a retrospective study in 47 patients. Patient Saf Surg 15(1):7
doi: 10.1186/s13037-020-00275-1
Jafari MD (2013) Morbidity of diverting ileostomy for rectal cancer: analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am Surg 79(10):1034–1039
doi: 10.1177/000313481307901016
Dukes’ Club Research, C (2021) Factors impacting time to ileostomy closure after anterior resection: the UK closure of ileostomy timing cohort study (CLOSE-IT). Colorectal Dis 23(5):1109–1119
doi: 10.1111/codi.15531
Omundsen M et al (2012) Early ileostomy closure: is there a downside? ANZ J Surg 82(5):352–354
doi: 10.1111/j.1445-2197.2012.06033.x
Dulskas A et al (2021) Quality of life and bowel function following early closure of a temporary ileostomy in patients with rectal cancer: a report from a single-center randomized controlled trial. J Clin Med 10(4):768
doi: 10.3390/jcm10040768
Audit NBC (2021) Annual Report 2021
Uimonen M et al (2021) The impact of the COVID-19 pandemic on waiting times for elective surgery patients: a multicenter study. PLoS ONE 16(7):e0253875
doi: 10.1371/journal.pone.0253875
Massucco P et al (2021) Prospective, randomised, multicentre, open-label trial, designed to evaluate the best timing of closure of the temporary ileostomy (early versus late) in patients who underwent rectal cancer resection and with indication for adjuvant chemotherapy: the STOMAD (STOMa closure before or after ADjuvant therapy) randomised controlled trial. BMJ Open 11(2):e044692
doi: 10.1136/bmjopen-2020-044692
Keane C et al (2019) Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg 106(5):645–652
doi: 10.1002/bjs.11092
Baek SJ et al (2014) Relationship between the severity of diversion colitis and the composition of colonic bacteria: a prospective study. Gut Liver 8(2):170–176
doi: 10.5009/gnl.2014.8.2.170
Bausys A et al (2019) Early versus standard closure of temporary ileostomy in patients with rectal cancer: a randomized controlled trial. J Surg Oncol 120(2):294–299
doi: 10.1002/jso.25488
Vogel I et al (2021) Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol 25(7):751–760
doi: 10.1007/s10151-021-02436-5
Aljorfi AA, Alkhamis AH (2020) A systematic review of early versus late closure of loop ileostomy. Surg Res Pract 2020:9876527
pubmed: 32953972
pmcid: 7481925
Higgins JPT et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928
doi: 10.1136/bmj.d5928
Guyatt GH et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926
doi: 10.1136/bmj.39489.470347.AD
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
doi: 10.1186/1471-2288-5-13
Alves A et al (2008) Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg 95(6):693–698
doi: 10.1002/bjs.6212
Danielsen AK et al (2017) Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg 265(2):284–290
doi: 10.1097/SLA.0000000000001829
Elsner AT et al (2021) Closure of temporary ileostomy 2 versus 12 weeks after rectal resection for cancer: a word of caution from a prospective, randomized controlled multicenter trial. Dis Colon Rectum 64(11):1398–1406
doi: 10.1097/DCR.0000000000002182
Klek S et al (2018) Early closure of the protective ileostomy after rectal resection should become part of the Enhanced Recovery After Surgery (ERAS) protocol: a randomized, prospective, two-center clinical trial. Wideochir Inne Tech Maloinwazyjne 13(4):435–441
pubmed: 30524612
pmcid: 6280077
Lasithiotakis K, Aghahoseini A, Alexander D (2016) Is early reversal of defunctioning ileostomy a shorter, easier and less expensive operation? World J Surg 40(7):1737–1740
doi: 10.1007/s00268-016-3448-7
Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48(11):2076–2079
doi: 10.1007/s10350-005-0146-1
Mehboob A et al (2020) Frequency and complications of ileostomy. Cureus 12(10):e11249
pubmed: 33274131
pmcid: 7707129
Nugent KP et al (1999) Quality of life in stoma patients. Dis Colon Rectum 42(12):1569–1574
doi: 10.1007/BF02236209
Meadows KA (2011) Patient-reported outcome measures: an overview. Br J Community Nurs 16(3):146–151
doi: 10.12968/bjcn.2011.16.3.146
Mason SJ et al (2018) Evaluating patient-reported outcome measures (PROMs) for bladder cancer: a systematic review using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. BJU Int 122(5):760–773
doi: 10.1111/bju.14368
Churruca K et al (2021) Patient-reported outcome measures (PROMs): A review of generic and condition-specific measures and a discussion of trends and issues. Health Expect 24(4):1015–1024
doi: 10.1111/hex.13254
Mou D et al (2020) The surgeon’s Perceived Value of Patient-reported Outcome Measures (PROMs): an exploratory qualitative study of 5 different surgical subspecialties. Ann Surg 275:500–505
doi: 10.1097/SLA.0000000000004253
Sokas C et al (2022) A review of PROM implementation in surgical practice. Ann Surg 275(1):85–90
doi: 10.1097/SLA.0000000000005029
Zhen L et al (2017) Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: a prospective study. Curr Probl Cancer 41(3):231–240
doi: 10.1016/j.currproblcancer.2017.02.007
Tulchinsky H et al (2014) Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy? J Surg Oncol 109(3):266–269
doi: 10.1002/jso.23493
Gu X (2020) Early ileostomy closure is safe and feasible during adjuvant chemotherapy after total mesorectal excision surgery for rectal cancer. J Clin Oncol 38:4111
doi: 10.1200/JCO.2020.38.15_suppl.4111
Khair G et al (2007) Routine use of gastrograffin enema prior to the reversal of a loop ileostomy. Dig Surg 24(5):338–341
doi: 10.1159/000107713
Sherman KL, Wexner SD (2017) Considerations in stoma reversal. Clin Colon Rectal Surg 30(3):172–177
doi: 10.1055/s-0037-1598157
Talboom K et al (2021) Highly selective diversion with proactive leakage management after low anterior resection for rectal cancer. Br J Surg 108(6):609–612
doi: 10.1093/bjs/znab018
Blok RD et al (2018) Impact of an institutional change from routine to highly selective diversion of a low anastomosis after TME for rectal cancer. Eur J Surg Oncol 44(8):1220–1225
doi: 10.1016/j.ejso.2018.03.033
Kim S et al (2021) The effect of anastomotic leakage on the incidence and severity of low anterior resection syndrome in patients undergoing proctectomy: a propensity score matching analysis. Ann Coloproctol 37(5):281–290
doi: 10.3393/ac.2021.03.15
Smith SA et al (2021) New ileostomy formation and subsequent community-onset acute and chronic kidney disease: a population-based cohort study. Ann Surg 274(2):352–358
doi: 10.1097/SLA.0000000000003617