ABSTRACT
Introduction: Rectal washout is proposed for eliminating free cancer cells, yet evidence on its efficacy in preventing local recurrence after anterior resection is inconclusive. Material and methods: 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. Results: 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. Conclusions: Rectal washout correlates with improved outcomes, while non-washout patients benefit more from neoadjuvant therapy. Notably, rectal washout without neoadjuvant remains efficacious.
