Early versus late closure of protective ileostomy after rectal cancer surgery.

TL;DR

Meta-analysis of 9 RCTs (387 patients) found no significant differences in major morbidity, anastomotic leakage, or functional outcomes between early (≤30 days) versus late (≥12 weeks) protective ileostomy closure after rectal cancer surgery, though early closure showed faster bowel function recovery and reduced costs.

Key findings

• Early ileostomy closure (≤30 days) is safe with comparable morbidity and anastomotic leakage rates to late closure (≥12 weeks)
• Early closure associated with faster time to first flatus and reduced stoma-related costs without affecting adjuvant chemotherapy delivery
• No differences in major complications, readmission, perioperative mortality, LARS, or quality of life between groups
• Authors recommend early closure in carefully selected patients but urge caution in high-risk cases pending further research on predictive risk factors

Why this matters at the bedside

Informs timing decisions for protective ileostomy reversal in rectal cancer patients by establishing comparable safety profiles while demonstrating cost and functional advantages of early closure, relevant for surgical planning and patient counseling.