International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1151–1159 | Cite as

Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: the dilemma remains

  • Shahin HajibandehEmail author
  • Shahab Hajibandeh
  • Diwakar Ryali Sarma
  • Jamie East
  • Shafquat Zaman
  • Rajnish Mankotia
  • Christopher Vaun Thompson
  • Andrew W Torrance
  • Rajeev Peravali



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,, 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.


Loop ileostomy closure Stoma reversal, adjuvant chemotherapy 


Author contribution

Conception and design: Shahin H, RP

Literature search and study selection: Shahin H, Shahab H, JE

Data collection: Shahin H, Shahab H

Analysis and interpretation: Shahin H, Shahab H

Writing the article: Shahin H, Shahab H

Critical revision of the article: All authors

Final approval of the article: All authors

Statistical analysis: Shahin H, Shahab H

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shahin Hajibandeh
    • 1
    Email author
  • Shahab Hajibandeh
    • 2
  • Diwakar Ryali Sarma
    • 1
  • Jamie East
    • 1
  • Shafquat Zaman
    • 1
  • Rajnish Mankotia
    • 1
  • Christopher Vaun Thompson
    • 1
  • Andrew W Torrance
    • 1
  • Rajeev Peravali
    • 1
  1. 1.Department of General SurgerySandwell and West Birmingham Hospitals NHS TrustBirminghamUK
  2. 2.Department of General Surgery, The Pennine Acute Hospitals NHS TrustNorth Manchester General HospitalManchesterUK

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