Unintended prolonged and permanent stoma following restorative rectal cancer surgery with defunctioning loop ileostomy: A systematic review and meta‐analysis
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| Natura: | Artículo Open Access |
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Wiley
2026
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| author | Paolo E. Meneghesso Edward Murphy Éanna J. Ryan Ruth Walsh Luca Risi Annalisa Maroli Caterina Foppa Antonino Spinelli Ronan A. Cahill |
| author_facet | Paolo E. Meneghesso Edward Murphy Éanna J. Ryan Ruth Walsh Luca Risi Annalisa Maroli Caterina Foppa Antonino Spinelli Ronan A. Cahill Paolo E. Meneghesso Edward Murphy Éanna J. Ryan Ruth Walsh Luca Risi Annalisa Maroli Caterina Foppa Antonino Spinelli Ronan A. Cahill |
| collection | Wiley Open Access |
| contents | Unintended prolonged and permanent stoma following restorative rectal cancer surgery with defunctioning loop ileostomy: A systematic review and meta‐analysis Paolo E. Meneghesso Edward Murphy Éanna J. Ryan Ruth Walsh Luca Risi Annalisa Maroli Caterina Foppa Antonino Spinelli Ronan A. Cahill Colorectal Disease Abstract Background An intentional temporary diverting loop ileostomy (DLI) is frequently part of restorative rectal cancer surgery. However, such a stoma itself risks morbidity and quality of life, especially when closure is delayed or impossible. We investigated the incidence and risk factors of such prolonged‐permanent stoma (PPS), defined as stoma persistence beyond 12 months from index surgery. Methods This systematic review and meta‐analysis was conducted in accordance with PRISMA guidelines and prospectively registered (PROSPERO ID: CRD420251066362). Literature databases were searched for studies describing patients with rectal adenocarcinoma undergoing restorative resection with DLI up to August 2025. Outcomes of interest were failure to become stoma‐free as expected and underlying risk factors. Study‐level covariate impact was explored via meta‐regression. Certainty of evidence and study quality were assessed by the GRADE and Newcastle‐Ottawa scales, respectively. Results Nineteen studies were included comprising 9932 patients of whom 18.7% (95% CI 15.3–22.5) had PPS. All were retrospective with 15 judged high quality. Seventeen potential predictors were identified and categorisable as being either tumour‐related, preoperative, operative or postoperative. Local or systemic recurrence, anastomotic leak and stage IV (cM+) at diagnosis were the strongest single predictors (each conferring approximately fivefold PPS‐risk). Other significant ( p < 0.05) predictors were comorbidity and ASA score, open surgery, neoadjuvant/adjuvant therapy and postoperative complications (all OR < 2). Meta‐regression identified study geography as a significant source of heterogeneity. GRADE certainty regarding predictors ranged from ‘very low’ to ‘moderate’ (tumour recurrence alone). Conclusion With nearly one in five cases of temporary DLI progressing to PPS, identified risk factors must be utilised to optimise patient care. More robust clinical studies are required. 10.1111/codi.70487 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1111/codi.70487 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_codi_70487 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Unintended prolonged and permanent stoma following restorative rectal cancer surgery with defunctioning loop ileostomy: A systematic review and meta‐analysis Paolo E. Meneghesso Edward Murphy Éanna J. Ryan Ruth Walsh Luca Risi Annalisa Maroli Caterina Foppa Antonino Spinelli Ronan A. Cahill Colorectal Disease Unintended prolonged and permanent stoma following restorative rectal cancer surgery with defunctioning loop ileostomy: A systematic review and meta‐analysis Paolo E. Meneghesso Edward Murphy Éanna J. Ryan Ruth Walsh Luca Risi Annalisa Maroli Caterina Foppa Antonino Spinelli Ronan A. Cahill Colorectal Disease Abstract Background An intentional temporary diverting loop ileostomy (DLI) is frequently part of restorative rectal cancer surgery. However, such a stoma itself risks morbidity and quality of life, especially when closure is delayed or impossible. We investigated the incidence and risk factors of such prolonged‐permanent stoma (PPS), defined as stoma persistence beyond 12 months from index surgery. Methods This systematic review and meta‐analysis was conducted in accordance with PRISMA guidelines and prospectively registered (PROSPERO ID: CRD420251066362). Literature databases were searched for studies describing patients with rectal adenocarcinoma undergoing restorative resection with DLI up to August 2025. Outcomes of interest were failure to become stoma‐free as expected and underlying risk factors. Study‐level covariate impact was explored via meta‐regression. Certainty of evidence and study quality were assessed by the GRADE and Newcastle‐Ottawa scales, respectively. Results Nineteen studies were included comprising 9932 patients of whom 18.7% (95% CI 15.3–22.5) had PPS. All were retrospective with 15 judged high quality. Seventeen potential predictors were identified and categorisable as being either tumour‐related, preoperative, operative or postoperative. Local or systemic recurrence, anastomotic leak and stage IV (cM+) at diagnosis were the strongest single predictors (each conferring approximately fivefold PPS‐risk). Other significant ( p < 0.05) predictors were comorbidity and ASA score, open surgery, neoadjuvant/adjuvant therapy and postoperative complications (all OR < 2). Meta‐regression identified study geography as a significant source of heterogeneity. GRADE certainty regarding predictors ranged from ‘very low’ to ‘moderate’ (tumour recurrence alone). Conclusion With nearly one in five cases of temporary DLI progressing to PPS, identified risk factors must be utilised to optimise patient care. More robust clinical studies are required. 10.1111/codi.70487 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Unintended prolonged and permanent stoma following restorative rectal cancer surgery with defunctioning loop ileostomy: A systematic review and meta‐analysis |
| topic | Colorectal Disease |
| url | https://onlinelibrary.wiley.com/doi/10.1111/codi.70487 |