title: Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sheng-Wen Wu, Cong-Chao Ma, Yu Yang, Department of General surgery, The Affiliated Jianhu Hospital of Nantong University, Jianhu People's Hospital, Jianhu 224700, Jiangsu Province, China.
authors.forename: Sheng-Wen
authors.initials: SW
authors.lastname: Wu
authors.affiliation: Sheng-Wen Wu, Cong-Chao Ma, Yu Yang, Department of General surgery, The Affiliated Jianhu Hospital of Nantong University, Jianhu People's Hospital, Jianhu 224700, Jiangsu Province, China.
authors.forename: Cong-Chao
authors.initials: CC
authors.lastname: Ma
authors.affiliation: Sheng-Wen Wu, Cong-Chao Ma, Yu Yang, Department of General surgery, The Affiliated Jianhu Hospital of Nantong University, Jianhu People's Hospital, Jianhu 224700, Jiangsu Province, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016017:Odds Ratio; D065840:Protective Factors; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D054047:Surgical Stomas / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Complication; Low anterior resection; Meta-analysis; Protective stoma; Rectal cancer