Association between irrigation fluids, washout volumes and risk of local recurrence of anterior resection for rectal cancer: a meta-analysis of 427 cases and 492 controls.
BACKGROUND
Rectal 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.


OBJECTIVE
To estimate the association between irrigation fluids types, volumes of rectal washout and risk of local recurrence after anterior resection for cancer.


METHODS
Relevant 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.


METHODS
Studies reporting the association between rectal washout types and volumes and risk of local recurrence after anterior resection for cancer were included.


METHODS
Eligible studies used rectal washout. Control groups were defined as no washout.


METHODS
Random-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.


RESULTS
Of 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.


CONCLUSIONS
The included studies were non-randomized observational studies, with diversity of study designs.


CONCLUSIONS
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.
Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Can
C
Zhou
Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Yu
Y
Ren
Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Juan
J
Li
Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Ke
K
Wang
Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Jianjun
J
He
Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Wuke
W
Chen
Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Peijun
P
Liu
D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012306:Risk; D007507:Therapeutic Irrigation