Should the rectal defect be closed following transanal local excision of rectal tumors? A systematic review and meta-analysis.

Abstract

Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect remains a controversial point and the available literature still remains unclear. Our aim was to determine through a systematic review of the literature and a meta-analysis of relevant studies whether or not the wall defect following TLE of rectal tumors should be closed. Medline and the Cochrane Trials Register were searched for trials published up to December 2016 comparing open versus closed management of the surgical rectal defect after TLE of rectal tumors. Meta-analysis was performed using Review Manager 5.0. Four studies were analyzed, yielding 489 patients (317 in the closed group and 182 in the open group). Meta-analysis showed no significant difference between the closed and open groups regarding the overall morbidity rate (OR 1.26; 95% CI 0.32-4.91; p=0.74), postoperative local infection rate (OR 0.62; 95% CI 0.23-1.62; p=0.33), postoperative bleeding rate (OR 0.83; 95% CI 0.29-1.77; p=0.63), and postoperative reintervention rate (OR 2.21; 95% CI 0.52-9.47; p=0.29). This review and meta-analysis suggest that there is no difference between closure or non-closure of wall defects after TLE.