Protocol: The role of defunctioning stoma prior to neoadjuvant therapy for locally advanced colonic and rectal cancer-A systematic review

Defunctioning stomas (ileostomy and colostomy) may be used prior to commencement of neoadjuvant therapy in patients with locally advanced colon or rectal cancer, in order to prevent clinical large bowel obstruction caused by radiotherapy associated oedema or progression of disease in patients who ar...

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Bibliographic Details
Published in:	PloS one Vol. 17; no. 9; p. e0275025
Main Authors:	Mesri, Mina, Hitchman, Louise, Yiaesemidou, Marina, Quyn, Aaron, Jayne, David, Chetter, Ian
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 22-09-2022 Public Library of Science (PLoS)
Subjects:	Abdominal surgery Anastomosis, Surgical - adverse effects Cancer Cancer therapies Care and treatment Chemotherapy Clinical trials Colon Colon - surgery Colon cancer Colorectal cancer Development and progression Edema Endoscopy Enterostomy Heterogeneity Humans Ileostomy Intestinal obstruction Intestine Literature reviews Medical prognosis Medicine and Health Sciences Meta-analysis Meta-Analysis as Topic Neoadjuvant Therapy Older people Ostomy Patient outcomes Patients Prevention Quality Radiation therapy Rectal Neoplasms - surgery Rectum Research and Analysis Methods Risk factors Statistical analysis Study Protocol Surgical Stomas - adverse effects Systematic review Systematic Reviews as Topic Tumors United Kingdom
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Summary:	Defunctioning stomas (ileostomy and colostomy) may be used prior to commencement of neoadjuvant therapy in patients with locally advanced colon or rectal cancer, in order to prevent clinical large bowel obstruction caused by radiotherapy associated oedema or progression of disease in patients who are not obstructed. However, the exact rate of clinical obstruction in patients undergoing neoadjuvant therapy who do not receive a defunctioning stoma is not known. Furthermore, it is not clear which factors predispose patients to developing clinical large bowel obstruction. Given that defunctioning stomas are associated with post operative and intra-operative risks, it is not currently possible to tailor defunctioning stomas to patients who have the greatest risk of developing obstruction. This systematic review which is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), aims to define the role of defunctioning stomas in prevention of obstruction patients with locally advanced colon or rectal cancer while undergoing neoadjuvant therapy. Two researchers will perform the literature search which will include all published and "in process" articles published in the English language between 2002-2022 in the following databases: EMBASE (OVID), MEDLINE (EBSCO), CINHAL complete, Web of Science, Cochrane Central Registry of Controlled Trials, Clinical Trials Registry. The full text of the selected articles will be independently screened by two researchers against the inclusion criteria. Data will be extracted from each article regarding: study design, participants, type of intervention and outcomes. The effect size will be expressed in incidence rates and when appropriate in relative risk with 95% confidence intervals. If possible, we will perform a meta-analysis. Heterogeneity will be assessed using I2 statistics. We will pool the data extracted from the randomised controlled trials to perform a meta-analysis using the Review Manager 5 software (RevMan 5). The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system will be used to assess the certainty of the evidence.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0275025