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Review
. 2014 Dec 21;20(47):18031-7.
doi: 10.3748/wjg.v20.i47.18031.

Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis

Sheng-Wen Wu  1 , Cong-Chao Ma  1 , Yu Yang  1
Affiliations
Review

Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis

Sheng-Wen Wu et al. World J Gastroenterol. .

Abstract

Aim: To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer.

Methods: The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger's tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant.

Results: A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I (2) = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry.

Conclusion: The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.

Keywords: Complication; Low anterior resection; Meta-analysis; Protective stoma; Rectal cancer.

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Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Forest plot. A: Forest plot for a comparison of the study outcomes of low anterior resection with or without stoma vs anastomotic leakage; B: Forest plot of the study outcomes of low anterior resection with or without stoma vs reoperation rate. Risk ratios are shown with 95%CIs.
Figure 3
Figure 3
Funnel plot. A: Funnel plot for the publication bias test of outcomes of low anterior resection with or without stoma vs anastomotic leakage; B: Funnel plot for the publication bias test regarding outcomes of low anterior resection with or without stoma vs reoperation rate. RR: Risk ratio.
See this image and copyright information in PMC

References

    1. Griffen FD, Knight CD, Whitaker JM, Knight CD. The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg. 1990;211:745–751; discussion 751-752. - PMC - PubMed
    1. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–351. - PubMed
    1. Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157–1168. - PubMed
    1. Bertelsen CA, Andreasen AH, Jørgensen T, Harling H. Anastomotic leakage after curative anterior resection for rectal cancer: short and long-term outcome. Colorectal Dis. 2010;12:e76–e81. - PubMed
    1. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg. 2008;196:592–598. - PubMed