title: Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery.
abstract: BACKGROUND
  The role of a defunctioning stoma in patients undergoing low anterior resection for rectal cancer is still the subject of controversy. Recent studies suggest reduced morbidity after low anterior rectal resection with a defunctioning stoma.
  
  
  METHODS
  Retrospective and prospective studies published between 1966 and 2007 were systematically reviewed. Randomized controlled trials (RCTs) comparing anterior resections with or without defunctioning stoma were included in a meta-analysis. The pooled estimates of clinically relevant anastomotic leakages and of reoperations were analyzed using a random effects model (odds ratio and 95% confidence interval, CI).
  
  
  RESULTS
  Relevant retrospective single (n = 18) and multicenter (n = 9) studies were identified and included in the systematic review. Analysis of incoherent data of the leakage rates in these nonrandomized studies demonstrated that a defunctioning stoma did not influence the occurrence of anastomotic failure but seemed to ameliorate the consequences of the leak. Four RCTs were included in the meta-analysis. The odds ratio for clinically relevant anastomotic leakage was 0.32 (95% CI 0.17-0.59), revealing a statistically significant benefit conferred through a defunctioning stoma (Z = 3.65, P = 0.0003). The odds ratio for reoperation because of leakage-caused complications was 0.27 (95% CI 0.14-0.51), with significantly fewer reoperations in patients with a defunctioning stoma (Z = 3.95, P < 0.0001). Overall mortality rates were comparable regardless of the presence of a defunctioning stoma.
  
  
  CONCLUSIONS
  A defunctioning stoma reduces the rate of clinically relevant anastomotic leakages and is thus recommended in surgery for low rectal cancers.
authors.affiliation: Department of Surgery, Technische Universität München, Munich, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hüser
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Michalski
authors.forename: Mert
authors.initials: M
authors.lastname: Erkan
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenberg
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
mesh_terms: D000714:Anastomosis, Surgical; D003125:Colostomy; D006801:Humans; D007081:Ileostomy; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation