Impact of surgeon volume on 18-month unclosed ileostomy rate after restorative rectal cancer resection

Prevalence and pooled risk factors of stoma outlet obstruction after colorectal surgery with diverting ileostomy: a systematic review and meta-analysis

BACKGROUND

Stoma outlet obstruction (SOO) is a significant complication following colorectal surgery with diverting ileostomy, but its prevalence and associated risk factors are not fully understood. This meta-analysis aimed to quantify the prevalence of SOO and identify key risk factors influencing its occurrence.

METHODS

A systematic review and meta-analysis of 19 studies comprising 3287 patients were conducted. Pooled prevalence and odds ratios (ORs) for risk factors were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity, and publication bias was assessed using funnel plots and Egger's regression test.

RESULTS

The pooled prevalence of SOO was 14% (95% CI = 11-18%, I2 = 84.9%). Subgroup analysis revealed higher prevalence in studies focusing on benign conditions (20%) and smaller sample sizes (< 100 patients, 16%). Key risk factors included high-output syndrome (OR = 4.23, 95% CI = 2.28-7.85), increased rectus abdominis thickness (OR = 3.51, 95% CI = 2.27-5.41), and laparoscopic surgery (OR = 4.04, 95% CI = 1.62-10.04). While publication bias was detected, but the trim-and-fill method indicated that the adjusted prevalence remained basically consistent with the overall pooled estimate.

CONCLUSIONS

SOO occurs in approximately 14% of patients undergoing colorectal surgery with diverting ileostomy. Key modifiable factors included high-output syndrome, rectus abdominis thickness, and laparoscopic surgery.

Risk factors and incidence of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma: A systematic review and meta-analysis

BACKGROUND

To further define the risk factors and incidence of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma.

METHODS

Records from five English databases and four Chinese databases. Odds ratios (OR) and 95 % confidence intervals (CI) were used to indicate the risk of inclusion of risk factors. The non-closure stoma rate used the risk difference (RD) and 95 % CI. Risk factors were evaluated for quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Risk factors of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma were Age ≥60 years[OR:1.57, 95%CI(1.44,1.72)], Tumor IV stage[OR:4.21, 95%CI(2.29,7.74)], American Society of Anesthesiologists (ASA)≥3[OR:1.48, 95%CI(1.33,1.65)], Neoadjuvant chemoradiotherapy[OR:1.41, 95%CI(1.09,1.82)],Open surgery[OR:1.45, 95%CI(1.09,1.93)], Postoperative chemotherapy[OR:1.37, 95%CI(1.03,1.82)], Anastomotic leakage[OR:4.61, 95%CI(2.86, 7.44)], Local recurrence[OR:7.16, 95%CI(4.70, 10.91)]. The rate of non-closure stoma after anterior resection for rectal cancer was: 0.20, 95 % CI (0.17, 0.23). The quality of evidence for stage IV tumors and anastomotic leakage was moderate, and other risk factors were low to very low.

CONCLUSIONS

Risk factors of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma were Age≥60 years, Tumor IV stage, ASA≥3, Neoadjuvant chemoradiotherapy, Open surgery, Postoperative chemotherapy, Anastomotic leakage, Local recurrence, and one in five anterior resection patients with a temporary stoma fails to close.