Rectal washout does not increase the complication risk after anterior resection for rectal cancer

Impact of rectal washout in local recurrence: a meta-analysis and systemic review

Introduction

Rectal washout is proposed for eliminating free cancer cells, yet evidence on its efficacy in preventing local recurrence after anterior resection is inconclusive.

Material and methods

Contrasting rectal washout (RW) and non-rectal washout (NRW) in rectal cancer, a prospective study of randomized control trials (RCT) and non-randomized control trials (NRCT) from January 2005 to July 2023 was conducted using PubMed, Cochrane Library, and MEDLINE databases. Meta-statistical analysis in RevMan 5.4 addressed heterogeneity.

Results

In analysis involving 19,855 patients (15127 RW, 4728 NRW) from eight studies, RW significantly reduced local recurrence (OR = 0.48), intraoperative RW (OR = 0.65), radical resection margins (OR = 1.89), and neoadjuvant therapy (OR = 0.99) (all p < 0.05). Subgroup RCT analysis reinforced these findings.

Conclusions

Rectal washout correlates with improved outcomes, while non-washout patients benefit more from neoadjuvant therapy. Notably, rectal washout without neoadjuvant remains efficacious.

Impact of rectal washout on recurrence and survival after anterior resection for rectal cancer

BACKGROUND

Rectal washout (RW) is routinely performed during anterior resection (AR) for rectal cancer to reduce local recurrence (LR), although is sometimes not performed during minimally invasive surgery (MIS) procedures due to technical challenges and time consumption. The aim was to investigate the impact of RW on the oncological outcome after AR for rectal cancer in a registry cohort.

METHODS

Data on patients registered in the Swedish Colorectal Cancer Registry who had undergone elective radical (R0) AR for TNM stage I-III rectal cancer between 2007 and 2017 with a 3-year follow-up were analysed. Multivariable analyses were performed and the primary endpoint was LR at 3 and 5 years after AR. The occurrence of distant metastasis (DM) and overall recurrence (OAR), overall survival, and relative survival were also analysed as a secondary aim. A subgroup analysis was performed for the same outcomes in patients treated with MIS.

RESULTS

Out of 6186 patients (1923 with TNM stage I, 1907 with TNM stage II, and 2356 with TNM stage III), RW was performed in 5706 (92.2 per cent). The median age of the cohort was 67 years. RW did not impact the 3-year risk of LR. LR within 5 years occurred in 104 of 4583 patients (2.3 per cent) in the RW group compared with 16 of 408 patients (3.9 per cent) in the no RW group (P = 0.037). In multivariable analysis of the LR risk, the HR was 0.53 (95 per cent c.i. 0.31 to 0.90), favouring RW. There were no differences in rates of DM and OAR, overall survival, and relative survival. A subgroup analysis of the 1410 patients undergoing MIS did not demonstrate any differences between the groups, given, however, the low rate of LR.

CONCLUSIONS

RW in AR for rectal cancer does not impact the 3-year oncological outcome; however, after the 5-year follow-up a reduction in LR risk was observed after RW.

The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

Background

Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery.

Methods

Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale.

Results

We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I² = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups.

Conclusion

The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-021-02432-x.

Nomogram to predict postoperative infectious complications after surgery for colorectal cancer: a retrospective cohort study in China

Background

Postoperative infectious complications (ICs) after surgery for colorectal cancer (CRC) increase in-hospital deaths and decrease long-term survival. However, the methodology for IC preoperative and intraoperative risk assessment has not yet been established. We aimed to construct a risk model for IC after surgery for CRC.

Methods

Between January 2016 and June 2020, a total of 593 patients who underwent curative surgery for CRC in Chengdu Second People’s Hospital were enrolled. Preoperative and intraoperative factors were obtained retrospectively. The least absolute shrinkage and selection operator (LASSO) method was used to screen out risk factors for IC. Then, based on the results of LASSO regression analysis, multivariable logistic regression analysis was performed to establish the prediction model. Bootstraps with 300 resamples were performed for internal validation. The performance of the model was evaluated with its calibration and discrimination. The clinical usefulness was assessed by decision curve analysis (DCA).

Results

A total of 95 (16.0%) patients developed ICs after surgery for CRC. Chronic pulmonary diseases, diabetes mellitus, preoperative and/or intraoperative blood transfusion, and longer operation time were independent risk factors for IC. A prediction model was constructed based on these factors. The concordance index (C-index) of the model was 0.761. The calibration curve of the model suggested great agreement. DCA showed that the model was clinically useful.

Conclusion

Several risk factors for IC after surgery for CRC were identified. A prediction model generated by these risk factors may help in identifying patients who may benefit from perioperative optimization.