Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies.

Wen-Long Gu,Sheng-Wen Wu

doi:10.1186/s12957-014-0417-1

Abstract

BackgroundRecent studies have shown that a protective stoma can reduce morbidity in low anterior resection for rectal cancer; however, the necessity of it is still controversially discussed.MethodsWe performed this meta-analysis to provide a comprehensive evaluation of the role of defunctioning stoma in low anterior resection for rectal cancer on the rates of anastomotic leakage and reoperation related to leakage with or without defunctioning stoma by calculating the pooled risk ratio.ResultsStudies and relevant literature published between 2004 and 2014 regarding the construction of a protective stoma after low anterior resection were searched though PubMed and EMBASE databases. Finally, a total of 13 studies including 8,002 patients were included in this meta-analysis. The results indicated that protective stomas significantly reduced the rate of postoperative anastomotic leakage and reoperation after low anterior rectal resection. The pooled risk ratios were 0.47 (95% CI: 0.33–0.68, P <0.0001) and 0.36 (95% CI: 028–0.46, P <0.00001), respectively.ConclusionsThe findings from this present meta-analysis suggest that a defunctioning stoma could effectively reduce the clinical consequences of anastomotic leakage and reoperation, it is recommended in patients undergoing low rectal anterior resection for rectal cancer.

Highlights

Recent studies have shown that a protective stoma can reduce morbidity in low anterior resection for rectal cancer; the necessity of it is still controversially discussed
The present meta-analysis demonstrated that the absence of a protective stoma was associated with a higher incidence of anastomotic leak and reoperation, with pooled risk ratio (RR) of 0.47 and 0.36, respectively
This revealed that a statistically significant advantage was conferred by a protective stoma in patients undergoing low anterior resection

Summary

Introduction

Recent studies have shown that a protective stoma can reduce morbidity in low anterior resection for rectal cancer; the necessity of it is still controversially discussed. Total mesorectal excision may be associated with an increased risk of developing anastomotic leakage with attendant morbidity and mortality in the postoperative period [3]. Several retrospective or non-randomized prospective studies have shown that the absence of a protective stoma is a risk factor for leakage after low anterior resection [9], but others have disputed this [10]. A defunctioning stoma is widely performed in low anterior resection for rectal cancer, it is still not clear whether protective stoma is useful for patients. The primary aim of this meta-analysis was to evaluate the validity for low anterior resection with and without the creation of a defunctioning stoma

Methods

Results

Discussion

Conclusion