ABSTRACT
BACKGROUND: A significant number of patients experience complications of the Kock pouch (KP) warranting revision or excision. This systematic review aimed to assess the pooled prevalence and risk factors for complications and failure of the KP. METHODS: This Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review (CRD42023416961) searched PubMed, Scopus, and Web of Science for studies on adult patients with Kock continent ileostomy published after the year 2000. The main outcome measures were revision, complications, and failure of the KP. Risk factors for complications and failure were assessed using a meta-regression analysis. Risk of bias was assessed using the ROBINS-1 tool. A proportional meta-analysis of the main outcomes was performed. RESULTS: A total of 19 studies (2042 patients) were included. The weighted mean prevalence of complications was 60.4% [95% confidence interval (CI): 46.1-74.7%], of pouch revision was 46.6% (95% CI: 38.5-54.7%), and of pouch failure was 12.9% (95% CI: 9.3-16.4%). Studies conducted in the USA had a mean failure prevalence of 12.6% (95% CI: 6.2-18.9%) comparable to studies conducted in Europe (11.1%; 95% CI: 7.5-14.7%). Factors associated with higher complications were increased body mass index (BMI) and previous ileoanal pouch anastomosis (IPAA); however, these factors were not associated with increased pouch failure. CONCLUSIONS: The KP is a highly complex operation as shown by a pooled complication prevalence of 60%, and thus, it should be only performed by experienced surgeons. Despite the high prevalence of complications and need for revisional surgery, patients are keen to preserve their KP. Increased BMI and a previous failed IPAA are risk factors for pouch complications, but not failure.
Subject(s)
Ileostomy , Postoperative Complications , Reoperation , Treatment Failure , Humans , Reoperation/statistics & numerical data , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Ileostomy/adverse effects , Ileostomy/methods , Risk Factors , Prevalence , Colonic Pouches/adverse effects , Female , Adult , Male , Proctocolectomy, Restorative/adverse effects , Proctocolectomy, Restorative/methods , Middle AgedABSTRACT
PURPOSE: Coffee drinking has been linked to many positive health effects, including reduced risk of some cancers. The present study aimed to provide an overview of the collective evidence on the association between coffee consumption and risk of colorectal cancer (CRC) through an umbrella review of the published systematic reviews. METHODS: This PRISMA-compliant systematic review of systematic reviews assessed the association between coffee drinking and the risk of CRC. An umbrella review approach was followed in a qualitative narrative manner. The quality of included reviews was assessed by the AMSTAR 2 checklist. The main outcome was the association between coffee drinking and CRC and colon and rectal cancer separately. RESULTS: Fourteen systematic reviews were included in this umbrella review. Coffee drinking was associated with a significant reduction in the risk of CRC according to five reviews (11-24%), colon cancer according to two reviews (9-21%), and rectal cancer according to one review (25%). One review reported a significant risk reduction of CRC by 7% with drinking six or more cups of coffee per day and another review reported a significant risk reduction of 8% with five cups per day reaching 12% with six cups per day. Decaffeinated coffee was associated with a significant risk reduction according to three reviews. CONCLUSION: The evidence supporting caffeinated coffee as associated with a reduced risk of CRC is inconsistent. Dose-dependent relation analysis suggests that the protective effect of coffee drinking against CRC is evident with the consumption of five or more cups per day.