Abstract
BackgroundRectal washout can prevent local recurrence after anterior resection of rectal cancer. Few studies have focused particularly on the association between irrigation fluids volume or agents and the risk of local recurrence after anterior resection of rectal cancer.ObjectiveTo estimate the association between irrigation fluids types, volumes of rectal washout and risk of local recurrence after anterior resection for cancer.Data SourcesRelevant studies were identified by a search of Medline, Embase, Wiley Online Library, China National Knowledge Infrastructure, Cochrane Oral Health Group Specialized Register, Wanfang databases and Google Website from their inception until October 18,2013.Study SelectionStudies reporting the association between rectal washout types and volumes and risk of local recurrence after anterior resection for cancer were included.InterventionsEligible studies used rectal washout. Control groups were defined as no washout.Study Appraisal and Synthesis MethodsRandom-effects model were used to obtain summary estimates of RR and 95% CI, with Stata version 11 and RevMan 5.2.5 softwares used. The quality of report was appraised in reference to the MINORS item.ResultsOf the 919 rectal cancer patients in 8 included studies, a total of 61(6.64%) cases of local recurrence were reported, with a pooled RR 0.51 (95%CI = 0.28–0.92, P = 0.03). The RRs 0.37 and 0.39 in normal saline and washout volume (≥1500 ml normal saline) subgroup, respectively, indicated that rectal washout with normal saline, or ≥1500 ml in volume could significantly reduce local recurrence (LR) rate (95% CI = 0.17–0.79, P = 0.01; 95% CI = 0.18–0.87, P = 0.02) after anterior resection for cancer.LimitationThe included studies were non-randomized observational studies, with diversity of study designs.ConclusionRectal washout with normal saline alone can reduce the risk of local recurrence in patients with resectable rectal cancer, and 1.5 liters rectal washout in volume is recommended.
Highlights
The RRs 0.37 and 0.39 in normal saline and washout volume ($1500 ml normal saline) subgroup, respectively, indicated that rectal washout with normal saline, or $1500 ml in volume could significantly reduce local recurrence (LR) rate after anterior resection for cancer
Rectal washout with normal saline alone can reduce the risk of local recurrence in patients with resectable rectal cancer, and 1.5 liters rectal washout in volume is recommended
Post-operative local recurrence (LR) of rectal cancer may yield severe outcomes that are associated with severely disabling symptoms and difficult to treat [1]
Summary
Post-operative local recurrence (LR) of rectal cancer may yield severe outcomes that are associated with severely disabling symptoms and difficult to treat [1]. This meta-analysis is conducted to comprehensively assess the overall evidence regarding local recurrence following rectal washout with different irrigation fluid types and washout volumes, by scrutinizing pertinent original research articles and analyzing the pooled data, with the aim of to provide meaningful clues for prevention of local recurrence after anterior resection in patients with rectal cancer. Few studies have focused on the effects of the volume or agents contained in the employed irrigation liquid. Few studies have focused on the association between irrigation fluids volume or agents and the risk of local recurrence after anterior resection of rectal cancer
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