Defunctioning Ileostomy Reduces Leakage Rate in Rectal Cancer Surgery - Systematic Review and Meta-analysis

Overview

Journal Oncotarget

Specialty Oncology

Date 2018 May 15

PMID 29755692

Citations 30

Authors

Magdalena Pisarska

Natalia Gajewska

Piotr Malczak

Michal Wysocki

Jan Witowski

Grzegorz Torbicz

Piotr Major

Magdalena Mizera

Marcin Dembinski

Marcin Migaczewski

Andrzej Budzynski

Michal Pedziwiatr

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Short-term outcomes of low anterior resection with and without ileostomy for low, mid and upper rectal cancers.

Xu V, La K, Ma R, Solis-Pazmino P, Smiley A, Barnajian M Updates Surg. 2025; .

PMID: 39847275 DOI: 10.1007/s13304-025-02088-2.

What Is the Role of the Gut Microbiota in Anastomotic Leakage After Colorectal Resection? A Scoping Review of Clinical and Experimental Studies.

Lianos G, Frountzas M, Kyrochristou I, Sakarellos P, Tatsis V, Kyrochristou G J Clin Med. 2024; 13(22).

PMID: 39597778 PMC: 11594793. DOI: 10.3390/jcm13226634.

Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR).

Peltrini R, Ferrara F, Parini D, Pacella D, Vitiello A, Scognamillo F Updates Surg. 2024; 77(1):97-106.

PMID: 39520612 DOI: 10.1007/s13304-024-02033-9.

Timing of Loop Ileostomy Closure Does Not Play a Pivotal Role in Terms of Complications-Results of the Liquidation of iLEOstomy (LILEO) Study.

Kisielewski M, Pisarska-Adamczyk M, Dowgiallo-Gornowicz N, Nawacki L, Serednicki W, Wierdak M J Pers Med. 2024; 14(9).

PMID: 39338188 PMC: 11433270. DOI: 10.3390/jpm14090934.

Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience.

Jones M, Moran B, Heald R, Bunni J Ann Coloproctol. 2024; 40(1):82-85.

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