Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis
Background and Objectives: Anterior rectal resection (ARR) represents one of the most frequently performed methods in colorectal surgery, mainly carried out for rectal cancer (RC) treatment. Defunctioning ileostomy (DI) has long been chosen as a method to “protect” colorectal or coloanal anastomosis...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/11/3607 |
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| author | Maurizio Zizzo Andrea Morini Magda Zanelli David Tumiati Francesca Sanguedolce Andrea Palicelli Federica Mereu Stefano Ascani Massimiliano Fabozzi |
| author_facet | Maurizio Zizzo Andrea Morini Magda Zanelli David Tumiati Francesca Sanguedolce Andrea Palicelli Federica Mereu Stefano Ascani Massimiliano Fabozzi |
| author_sort | Maurizio Zizzo |
| collection | DOAJ |
| description | Background and Objectives: Anterior rectal resection (ARR) represents one of the most frequently performed methods in colorectal surgery, mainly carried out for rectal cancer (RC) treatment. Defunctioning ileostomy (DI) has long been chosen as a method to “protect” colorectal or coloanal anastomosis after ARR. However, DI does not rule out risks of more or less serious complications. A proximal intra-abdominal closed-loop ileostomy, the so-called virtual/ghost ileostomy (VI/GI), could limit the number of DIs and the associated morbidity. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Meta-analysis was performed by use of RevMan [Computer program] Version 5.4. Results: The five included comparative studies (VI/GI or DI) covering an approximately 20-year study period (2008–2021). All included studies were observational ones and originated from European countries. Meta-analysis indicated VI/GI as significantly associated with lower short-term morbidity rates related to VI/GI or DI after primary surgery (RR: 0.21, 95% CI: 0.07–0.64, <i>p</i> = 0.006), fewer dehydration (RR: 0.17, 95% CI: 0.04–0.75, <i>p</i> = 0.02) and ileus episodes after primary surgery (RR: 0.20, 95% CI: 0.05–0.77, <i>p</i> = 0.02), fewer readmissions after primary surgery (RR: 0.17, 95% CI: 0.07–0.43, <i>p</i> = 0.0002) and readmissions after primary surgery plus stoma closure surgery (RR: 0.14, 95% CI: 0.06–0.30, <i>p</i> < 0.00001) than the DI group. On the contrary, no differences were identified in terms of AL after primary surgery, short-term morbidity after primary surgery, major complications (CD ≥ III) after primary surgery and length of hospital stay after primary surgery. <i>Conclusions</i>: Given the significant biases among meta-analyzed studies (small overall sample size and the small number of events analyzed, in particular), our results require careful interpretation. Further randomized, possibly multi-center trials may be of paramount importance in confirming our results. |
| first_indexed | 2024-03-11T03:04:29Z |
| format | Article |
| id | doaj.art-44f9d6a8d82c4f0f8611bfadfa8f6c8d |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T03:04:29Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-44f9d6a8d82c4f0f8611bfadfa8f6c8d2023-11-18T08:03:57ZengMDPI AGJournal of Clinical Medicine2077-03832023-05-011211360710.3390/jcm12113607Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-AnalysisMaurizio Zizzo0Andrea Morini1Magda Zanelli2David Tumiati3Francesca Sanguedolce4Andrea Palicelli5Federica Mereu6Stefano Ascani7Massimiliano Fabozzi8Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalySurgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalyPathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalySurgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalyPathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, ItalyPathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalySurgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalyHematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, 06129 Perugia, ItalySurgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, ItalyBackground and Objectives: Anterior rectal resection (ARR) represents one of the most frequently performed methods in colorectal surgery, mainly carried out for rectal cancer (RC) treatment. Defunctioning ileostomy (DI) has long been chosen as a method to “protect” colorectal or coloanal anastomosis after ARR. However, DI does not rule out risks of more or less serious complications. A proximal intra-abdominal closed-loop ileostomy, the so-called virtual/ghost ileostomy (VI/GI), could limit the number of DIs and the associated morbidity. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Meta-analysis was performed by use of RevMan [Computer program] Version 5.4. Results: The five included comparative studies (VI/GI or DI) covering an approximately 20-year study period (2008–2021). All included studies were observational ones and originated from European countries. Meta-analysis indicated VI/GI as significantly associated with lower short-term morbidity rates related to VI/GI or DI after primary surgery (RR: 0.21, 95% CI: 0.07–0.64, <i>p</i> = 0.006), fewer dehydration (RR: 0.17, 95% CI: 0.04–0.75, <i>p</i> = 0.02) and ileus episodes after primary surgery (RR: 0.20, 95% CI: 0.05–0.77, <i>p</i> = 0.02), fewer readmissions after primary surgery (RR: 0.17, 95% CI: 0.07–0.43, <i>p</i> = 0.0002) and readmissions after primary surgery plus stoma closure surgery (RR: 0.14, 95% CI: 0.06–0.30, <i>p</i> < 0.00001) than the DI group. On the contrary, no differences were identified in terms of AL after primary surgery, short-term morbidity after primary surgery, major complications (CD ≥ III) after primary surgery and length of hospital stay after primary surgery. <i>Conclusions</i>: Given the significant biases among meta-analyzed studies (small overall sample size and the small number of events analyzed, in particular), our results require careful interpretation. Further randomized, possibly multi-center trials may be of paramount importance in confirming our results.https://www.mdpi.com/2077-0383/12/11/3607anterior rectal resectionrectumileostomycolorectal cancersurgeryoutcomes |
| spellingShingle | Maurizio Zizzo Andrea Morini Magda Zanelli David Tumiati Francesca Sanguedolce Andrea Palicelli Federica Mereu Stefano Ascani Massimiliano Fabozzi Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis Journal of Clinical Medicine anterior rectal resection rectum ileostomy colorectal cancer surgery outcomes |
| title | Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis |
| title_full | Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis |
| title_fullStr | Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis |
| title_full_unstemmed | Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis |
| title_short | Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis |
| title_sort | short term outcomes in patients undergoing virtual ghost ileostomy or defunctioning ileostomy after anterior resection of the rectum a meta analysis |
| topic | anterior rectal resection rectum ileostomy colorectal cancer surgery outcomes |
| url | https://www.mdpi.com/2077-0383/12/11/3607 |
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