REVIEW Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: the dilemma remains Shahin Hajibandeh 1 & Shahab Hajibandeh 2 & Diwakar Ryali Sarma 1 & Jamie East 1 & Shafquat Zaman 1 & Rajnish Mankotia 1 & Christopher Vaun Thompson 1 & Andrew W Torrance 1 & Rajeev Peravali 1 Accepted: 17 May 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Objective To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed effects or random effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82–2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47–16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80–4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50–2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI - 0.85–0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of the best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to the closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on the completeness of chemotherapy and quality of life which can determine the appropriateness of either approach. Keywords Loop ileostomy closure . Stoma reversal, adjuvant chemotherapy Introduction Rectal cancer is one of the most common cancers worldwide with increasing incidence [1]. A temporary stoma is often used in rectal cancer surgery to protect a distal anastomosis, particularly after low anterior resection (LAR) which is the treatment of choice for rectal cancer of the middle and lower third [2–4]. Patients with a temporary protecting ileostomy (diverting stoma) are at lower risk of anastomotic leak, peri- tonitis and their associated morbidity and mortality [5, 6]. Loop ileostomies are generally not closed earlier than 2 months after primary surgery. In a large number of patients, this not only is associated with stoma-related morbidities but also would cause discomfort and affect their quality of life [7, 8]. Despite the existence of considerable pressure from the patients to close the protecting stoma as soon as possible, high-level evidence on the optimal timing of stoma closure is lacking. Although early closure of the protecting stoma has been demonstrated to be safe [9–12], it may negatively influence the completeness of chemotherapy due to complica- tions including anastomotic leakage or LAR syndrome [13]. Shahin Hajibandeh and Shahab Hajibandeh equally contributed to this paper and joint first authorship is proposed. * Shahin Hajibandeh shahin_hajibandeh@yahoo.com 1 Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK 2 Department of General Surgery, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Manchester, UK International Journal of Colorectal Disease https://doi.org/10.1007/s00384-019-03321-2