title: Defunctioning stoma in low anterior resection for rectal cancer: a meta- analysis of five recent studies.
abstract: OBJECTIVE
  The necessity of a defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer remains controversial. This meta-analysis evaluates the advantages of prophylactic stomas in patients undergoing low anterior resection and assesses postoperative outcomes of patients with or without a defunctioning stoma.
  
  
  METHODS
  Studies and relevant literatures regarding the formation of defunctioning stomas after low anterior resection were searched through PubMed and Embase. The rates of anastomotic leakage and re-operation related to leakage with or without defunctioning stoma were pooled and compared using a meta-analysis. The risk ratios were calculated with 95% confidence intervals to evaluate the influence of defunctioning stomas.
  
  
  RESULTS
  Five recent studies including 878 patients in total were included in this meta-analysis. These studies demonstrated that defunctioning stomas significantly reduced the rate of postoperative anastomotic leakage and reoperation after low anterior resection, the pooled risk ratio was 0.34 (95% CI=0.22-0.53, p<0.00001) and 0.27 (95% CI=0.16-0.48, p<0.00001), respectively.
  
  
  CONCLUSIONS
  Defunctioning stomas can be useful to minimize the rate of anastomotic leakage and re-operation related to leakage. Furthermore, anorectal function was not affected. However, the influence of a defunctioning stoma on long-term mortality and the quality of life in patients treated for rectal cancer is inconclusive.
authors.affiliation: Department of Gastrointestinal Surgery, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Dao-Rong
authors.initials: DR
authors.lastname: Wang
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Yu
authors.forename: Ze-Kun
authors.initials: ZK
authors.lastname: Zhao
authors.forename: Liu-Hua
authors.initials: LH
authors.lastname: Wang
authors.forename: Yong-Kun
authors.initials: YK
authors.lastname: Li
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006801:Humans; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D054047:Surgical Stomas / Q000009:adverse effects; D016896:Treatment Outcome