Work

Timing of diverting ileostomy closure after low anterior resection for rectal cancer: a GRADE-assessed systematic review and meta-analysis of early and delayed closure

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: PURPOSE: To compare early and delayed diverting ileostomy closure after low anterior resection for rectal cancer, focusing on postoperative morbidity and recovery outcomes, and to assess the certainty of available evidence. METHODS: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to 26th April, 2026. Five comparative studies (four randomized trials and one prospective cohort; 512 participants) were included. Random-effects meta-analyses evaluated overall post-closure morbidity as the primary outcome and severe complications, index-to-closure interval, postoperative hospital stay, operative time, and reoperation as secondary outcomes. Certainty was assessed using GRADE. RESULTS: Overall morbidity occurred in 52/257 patients after early closure and 50/255 after delayed closure (RR 1.06, 95% CI 0.66-1.71; τ²=0.12; I²=40%). Severe complications and reoperation did not differ statistically, with confidence intervals compatible with benefit or harm. The index-to-closure interval was 107.09 days shorter with early closure (95% CI - 153.01 to - 61.17; τ²=2023.39; I²=96%); this process measure was largely inherent to the group definitions. Hospital stay and operative time did not differ statistically. CONCLUSION: The available evidence does not demonstrate a statistically significant difference in postoperative morbidity but does not establish equivalence. Early closure may be considered in selected patients after postoperative recovery and assessment of anastomotic integrity; however, these findings do not support routine early closure in all patients.

Source: Langenbeck s Archives of Surgery

DOI: 10.1007/s00423-026-04350-6