Early closure of defunctioning ileostomy after low-pelvic surgery for rectal cancer: Systematic review and meta-analysis of safety and functional outcomes.

BACKGROUND

Preventive defunctioning ileostomy is widely used to prevent leaks in high-risk colorectal anastomosis, but here is no international consensus on the timing of stoma reversal. In this study we aim to evaluate the safety and functional outcomes of early versus late defunctioning ileostomy after low-pelvic surgery for rectal cancer.

METHODS

Systematic literature search was performed in multiple electronic databases until September 30, 2025. Meta-analysis and trial-sequantial analysis (TSA) were performed using the RevMan 5.4 and Copenhagen Trial Unit TSA software.

RESULTS

There was no significant difference in overall postoperative morbidity, major morbidity, operation time, blood loss, incidence of postoperative ileus/bowel obstruction, length of stay (LOS), and reoperation rate between two groups. Functional outcomes like the incidence of major low anterior resection syndrome (LARS) and the minor LARS were also similar in two groups.

CONCLUSION

There is no increased risk of morbidity with early closure of defunctioning ileostomy after colorectal cancer surgery and the functional outcomes were also similar. Therefore, early reversal may be a safe and feasible approach in precisely selected cases when the clinician feels supported in doing so.