Early versus late closure of a protective ileostomy following surgery for rectal cancer: a systematic review

The aim was to analyse the safety and clinical outcomes of early closure versus conventional or late closure of a protective ileostomy in patients undergoing curative surgery for rectal cancer; a systematic review was conducted in accordance with the PRISMA 2020 guidelines. The search was carried out in PubMed, Embase, the Cochrane Library, Web of Science and Scopus, including clinical trials and comparative observational studies that assessed different timings of ileostomy reversal. Due to the clinical and methodological heterogeneity among the studies, the results were synthesised using a descriptive and narrative approach, taking into account postoperative morbidity, major complications, ileus or bowel obstruction, stoma-related complications, bowel function and quality of life. The included studies showed variable results depending on the timing of closure and patient selection criteria. In general, early closure yielded results comparable to those of late closure in carefully selected patients and reduced the duration of exposure to stoma-related complications; however, in some studies, very early closure protocols were associated with an increase in complications and reoperations. It is concluded that early closure may constitute a safe and feasible alternative to late closure when there is appropriate patient selection and an active anastomotic complication has been ruled out; however, the heterogeneity of the evidence limits its widespread application.