Impact of rectal washout in local recurrence: a meta-analysis and systemic review

Rectal washout is proposed for eliminating free cancer cells, yet evidence on its efficacy in preventing local recurrence after anterior resection is inconclusive. Contrasting rectal washout (RW) and non-rectal washout (NRW) in rectal cancer, a prospective study of randomized control trials (RCT) and non-randomized control trials (NRCT) from January 2005 to July 2023 was conducted using PubMed, Cochrane Library, and MEDLINE databases. Meta-statistical analysis in RevMan 5.4 addressed heterogeneity. In analysis involving 19,855 patients (15127 RW, 4728 NRW) from eight studies, RW significantly reduced local recurrence (OR = 0.48), intraoperative RW (OR = 0.65), radical resection margins (OR = 1.89), and neoadjuvant therapy (OR = 0.99) (all p < 0.05). Subgroup RCT analysis reinforced these findings. Rectal washout correlates with improved outcomes, while non-washout patients benefit more from neoadjuvant therapy. Notably, rectal washout without neoadjuvant remains efficacious.