AIM This systematic review aims to assess dehydration-related prevalence and morbidity from diverting ileostomy compared to resections without ileostomy formation in adults undergoing colorectal resection for cancer. METHOD MEDLINE, Embase, CENTRAL and Clinicaltrials.gov were searched for studies of any design that reported dehydration, renal function and dehydration-related morbidity in adult colorectal cancer patients with diverting ileostomy (last search 12/08/2020). Bias was assessed using the Cochrane Collaborations tool for assessing risk of bias in randomised trials and the Risk Of Bias in Non-randomised studies of Interventions tools. RESULTS Of 1927 screened papers, 22 studies were included (21 cohort studies and one randomised trial) with a total of 19485 patients (12209 with ileostomy). Prevalence of dehydration was 9.00% (95% CI 5.31-13.45,p<0.001). Relative risk of dehydration following diverting ileostomy was 3.37 (95% CI 2.30-4.95, p<0.001). Three studies assessing long term trends in renal function demonstrated progressive renal impairment persisting beyond the initial insult. Consequences identified included unplanned readmission, delay or non-commencement of adjuvant chemotherapy, and development of chronic kidney disease. DISCUSSION Significant dehydration is common following diverting ileostomy and is linked to both acute kidney injury and has a long-term impact on renal function. This study suggests ileostomy confers significant morbidity particularly related to dehydration and renal impairment.
Risk and consequences of dehydration following colorectal cancer resection with diverting ileostomy. A systematic review and meta-analysis.