Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer.
BACKGROUND
A defunctioning stoma is frequently created to minimize the impact of any subsequent anastomotic leak after a low rectal anastomosis. This review evaluates the need for routine stoma formation.


METHODS
A meta-analysis was performed of randomized controlled trials (RCTs) and non-randomized studies with an interventional group evaluating the need for a defunctioning stoma after low anterior resection for rectal cancer. Primary outcomes analysed included clinical anastomotic leak rate, reoperation rate and mortality related to leak.


RESULTS
Four RCTs and 21 non-randomized studies, with 11,429 patients in total, were analysed. Meta-analysis of the RCTs showed a lower clinical anastomotic leak rate (risk ratio (RR) 0.39 (95 per cent c.i. 0.23 to 0.66); P < 0.001) and a lower reoperation rate (RR 0.29 (0.16 to 0.53); P < 0.001) in the stoma group. Meta-analysis of the non-randomized studies showed a lower clinical anastomotic leak rate (RR 0.74 (0.67 to 0.83); P < 0.001), lower reoperation rate (RR 0.28 (0.23 to 0.35); P < 0.001) and lower mortality rate (RR 0.42 (0.28 to 0.61); P < 0.001) in the stoma group.


CONCLUSIONS
A defunctioning stoma decreases clinical anastomotic leak rate and reoperation rate. It is recommended after low anterior resection for rectal cancer.
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
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Tan
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Tang
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D000714:Anastomosis, Surgical / Q000401:mortality; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D054047:Surgical Stomas / Q000502:physiology*; D013529:Surgical Wound Dehiscence / Q000601:surgery; D016896:Treatment Outcome