Evidence map›Paper›PMID 42875765›Full record

Trial reportBMC surgery2026

Routine versus postoperative CRP/CT guided selective diverting ileostomy after laparoscopic low anterior resection for rectal cancer: a comparative randomized controlled trial.

Ahmed M Moaz, Khaled E Barakat, Walid Elshazly, Yasser Zaki, Amr Badawy, Bassem Kh Hegazy, Ahmed M Mohieldein

Registry-linked trialAbstract readRandomized Controlled TrialComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07722533 (Role of Serial C-reactive Protein Concentration Analysis With Computed Tomography in Limiting the Need for Protective Defunctioning Ileostomy After Laparoscopic Low Anterior Resection - A Prospective Study), which is not on this map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07722533 nacompletednot on this map

Role of Serial C-reactive Protein Concentration Analysis With Computed Tomography in Limiting the Need for Protective Defunctioning Ileostomy After Laparoscopic Low Anterior Resection - A Prospective Study

TypeinterventionalSponsorAlexandria UniversityRan2022 to 2026Enrolled60ConditionsRectal Cancer Patients, Anastomotic Leakage, Low Anterior ResectionArmsSerial C-reactive protein-guided computed tomography surveillance and selective omission of defunctioning ileostomy, routine follow up
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Ahmed M MoazColorectal Surgery Unit, Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.ORCID http://orcid.org/0009-0007-4784-2917
Khaled E BarakatSurgical Oncology Unit, Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. khaled.elsayed1495@alexmed.edu.eg.ORCID http://orcid.org/0009-0000-3626-1331
Walid ElshazlyColorectal Surgery Unit, Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.ORCID http://orcid.org/0000-0001-9987-520X
Yasser ZakiColorectal Surgery Unit, Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Amr BadawyUpper GIT and Liver Surgery Unit A, Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.ORCID http://orcid.org/0000-0001-9298-792X
Bassem Kh HegazySurgery Department, Faculty of Medicine, Portsaid University, Portsaid, Egypt.
Ahmed M MohieldeinColorectal Surgery Unit, Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.ORCID http://orcid.org/0009-0006-2987-9436

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiverting ileostomy is routinely used to protect the anastomosis after laparoscopic low anterior resection (LAR) for rectal cancer, but it exposes most patients to stoma-related morbidity even though only a minority develop a true anastomotic leak. This trial evaluated whether a postoperative C-reactive protein (CRP) and computed tomography (CT) guided selective ileostomy strategy could reduce the rate of ileostomy formation compared with routine diversion.

methodsIn this RCT, 200 patients with stage II or III middle or lower third rectal cancer undergoing laparoscopic LAR were randomized 1:1 to a CRP/CT-guided selective ileostomy group (n = 100) or a routine diverting ileostomy group (n = 100). In the CRP/CT group, serum CRP was measured daily from postoperative day 1; a threshold of 114 mg/L on day 3 or a rise greater than 15 mg/L per day triggered confirmatory contrast-enhanced CT, with ileostomy formed only if findings were suspicious for leak. The primary outcome was the stoma-free status throughout the 12-month follow-up.

resultsBaseline demographic and tumor characteristics were similar between groups (all p > 0.05). Ileostomy formation was markedly lower in the CRP/CT group than the routine group (22.0% vs. 100.0%, p < 0.001). Anastomotic leak rates did not differ (0% vs. 1.0%, p = 1.000), nor did overall complication rates (31.0% vs. 32.0%, p = 0.879). Operative time (148.4 ± 14.0 vs. 166.6 ± 13.1 min, p < 0.001) and intraoperative blood loss (168.9 ± 28.2 vs. 197.3 ± 39.7 mL, p < 0.001) were significantly lower in the CRP/CT group. Stoma-related complications were far less frequent with the selective strategy (3.0% vs. 30.0%, p < 0.001). The CRP/CT group reported significantly better global health status, physical functioning, and emotional functioning scores (all p < 0.001).

conclusionA postoperative CRP/CT-guided selective ileostomy strategy reduces the need for diverting ileostomy after laparoscopic low anterior resection for rectal cancer while improving operative outcomes and quality of life; however, confirmed leakage was infrequent in both groups. This approach may serve as an alternative to routine diversion in appropriately monitored surgical units.

trial registrationThis trial was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07722533) on July 17, 2026.

Indexed as

C-Reactive ProteinIleostomyLaparoscopyRectal NeoplasmsTomography, X-Ray ComputedAgedAnastomotic LeakColorectal Surgical ProceduresFemaleHumansMaleMiddle AgedC-Reactive ProteinAnastomotic leakC-reactive proteinDiverting ileostomyLow anterior resectionRectal cancerSelective ileostomy

Identifiers

PMID42875765
PMCPMC13670677

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.