Chan Dedrick Kok Hong, Lau Jerrald, Kah-Hwee Tan Jarrod, Buan Bryan Jun Liang, Lee Kai-Yin, Lin Norman Sihan, Tan Ian Jse-Wei, Ng Jing-Yu, Lieske Bettina, Cheong Wai-Kit, Tan Ker-Kan
Division of Colorectal Surgery, National University Hospital, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
BMC Gastroenterol. 2025 Jul 1;25(1):491. doi: 10.1186/s12876-025-04090-9.
A defunctioning ileostomy is frequently created to avert the implications of a colo-rectal anastomotic dehiscence in rectal cancer surgery. The timing of closure of the ileostomy remains debatable as it is believed that early closure (EC) may be beneficial to most patients than the standard practice of late closure (LC). This meta-analysis was performed to compare surgical outcomes in patients who underwent EC versus LC.
Randomised controlled trials (RCT) which evaluated the effect of EC versus LC of ileostomy on surgical outcomes in rectal cancer patients was searched on PubMed, Web of Science, Embase and Cochrane Library. RCTs evaluating EC vs. LC of defunctioning ileostomies for rectal cancer patients were included. The primary outcome measures include overall morbidity, surgical complications, anastomotic dehiscence, and reoperation rates.
Five RCTs were included in this meta-analysis of 387 patients. The pooled estimate of the OR for overall morbidity (OR 1.80, 95% CI 0.97-3.31; p = 0.06), reoperation (OR 2.57, 95% CI 0.72-9.14; p = 0.14), and anastomotic leakage (OR 3.25, 95% CI 0.40-26.38; p = 0.27) were not statistically significant. EC however resulted in a statistically significant increase in terms of surgical complications (OR 2.63, 95% CI 1.04-6.67; p = 0.04). These studies had low to moderate levels of statistical heterogeneity.
EC of defunctioning ileostomy in rectal cancer patients results in increased surgical complications compared to patients with LC. Caution must be undertaken in patients in whom an EC is performed.
在直肠癌手术中，常通过建立失功性回肠造口术来避免结直肠吻合口裂开的影响。回肠造口术关闭的时机仍存在争议，因为人们认为早期关闭（EC）可能比晚期关闭（LC）的标准做法对大多数患者更有益。本荟萃分析旨在比较接受EC与LC的患者的手术结局。
在PubMed、科学网、Embase和Cochrane图书馆中检索评估回肠造口术的EC与LC对直肠癌患者手术结局影响的随机对照试验（RCT）。纳入评估直肠癌患者失功性回肠造口术的EC与LC的RCT。主要结局指标包括总体发病率、手术并发症、吻合口裂开和再次手术率。
本荟萃分析纳入了5项RCT，共387例患者。总体发病率（OR 1.80，95%CI 0.97 - 3.31；p = 0.06）、再次手术（OR 2.57，95%CI 0.72 - 9.14；p = 0.14）和吻合口漏（OR 3.25，95%CI 0.40 - 26.38；p = 0.27）的合并OR估计值无统计学意义。然而，EC导致手术并发症在统计学上显著增加（OR 2.63，95%CI 1.04 - 6.67；p = 0.04）。这些研究的统计异质性水平低至中等。
与接受LC的患者相比，直肠癌患者失功性回肠造口术的EC会导致手术并发症增加。对接受EC的患者必须谨慎。
