Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Department of General Surgery, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Manchester, UK.
Int J Colorectal Dis. 2019 Jul;34(7):1151-1159. doi: 10.1007/s00384-019-03321-2. Epub 2019 May 25.
To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection.
We systematic searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov , ISRCTN Register and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed effects or random effects models.
We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI - 0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses.
The meta-analysis of the best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to the closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on the completeness of chemotherapy and quality of life which can determine the appropriateness of either approach.
评估直肠癌切除术后辅助化疗期间或之后行临时性回肠袢式造口关闭术的对比结局。
我们系统地检索了 MEDLINE、EMBASE、CINAHL、CENTRAL、世界卫生组织国际临床试验注册平台、ClinicalTrials.gov、ISRCTN 注册库和参考文献列表。评估的结局参数包括整体围手术期并发症、吻合口漏、手术部位感染、肠梗阻和住院时间。使用固定效应或随机效应模型计算联合总体效应量。
我们确定了 4 项研究，共纳入 436 例患者，比较了直肠癌切除术后辅助化疗期间（n=185）或之后（n=251）行临时性回肠袢式造口关闭术的结局。两组患者整体围手术期并发症（OR 1.39；95%CI 0.82-2.36，p=0.22）、吻合口漏（OR 2.80；95%CI 0.47-16.56，p=0.26）、手术部位感染（OR 1.97；95%CI 0.80-4.90，p=0.14）、肠梗阻（OR 1.22；95%CI 0.50-2.96，p=0.66）或住院时间（MD 0.02；95%CI -0.85-0.89，p=0.97）差异均无统计学意义。所有分析的异质性均较低。
尽管最佳证据有限，但荟萃分析表明，直肠癌切除术后辅助化疗期间行临时性回肠袢式造口关闭术与辅助化疗后行造口关闭术的结局可能相当。我们鼓励未来的研究集中于化疗的完整性和生活质量，这可以决定两种方法的适宜性。
