The effect of rectal washout during anterior resection for prevention local tumor recurrence: A meta-analysis

Objective: To investigate the effect of rectal washout (WO) for the prevention of local recurrence (LR) in patients with resectable rectal cancer. Methods: Relevant studies that compared rectal WO with no washout (NWO) for rectal cancer resection and were published between January 1980 and January 2011 were retrieved. Random-effect meta-analysis was used and subgroup analysis was performed. Results: Of the six studies that matched the selection criteria, one reported 10 patients with LR and 67 patients without LR within 5 years, who were unknown to belong to WO group or NWO group, with an overall LR rate of 7.7 percent (367/4776). LR rate in the WO group was 6.4 percent (240/3732) as compared with 12.2 percent (127/1044) in the NWO group, with a significant difference (OR=0.51, 95 percent CI=0.41-0.69, P<0.01). When incorporating the 10 patients with LR into the WO group or into the NWO group, LR rate was higher in the NWO group than in the WO group, with an overall LR rate of 7.8 percent (377/4852), 12.2 percent (127/1044) vs. 6.6 percent (250/3808) or 12.3 percent (137/1111) vs. 6.4 percent (240/3732), respectively, and there were significant differences between them (OR=0.51, 95 percent CI=0.40-0.65, P<0.01; OR=0.49, 95 percent CI=0.39-0.62, P<0.01). Conclusion: As a relatively risk-free procedure, rectal washout during anterior resection can effectively prevent the local recurrence rate of rectal cancer.