Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2014; 20(47): 18031-18037
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.18031
Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis
Sheng-Wen Wu, Cong-Chao Ma, Yu Yang
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
Author contributions: Wu SW carried out data analysis and wrote the manuscript; Ma CC provided supervision; Wu SW and Yang Y identified and acquired reports of trials, abstracted the data and assessed the risk of bias; Wu SW conducted the statistical analyses and contacted authors of included studies to obtain additional information; Ma CC drafted the manuscript; all the authors contributed to the interpretation of data, critically revised the manuscript and approved the final version of the manuscript submitted for publication and are guarantors for the study.
Correspondence to: Cong-Chao Ma, MD, PhD, Department of General surgery, The Affiliated Jianhu Hospital of Nantong University, Jianhu People’s Hospital, Renming South-road 275, Jianhu 224700, Jiangsu Province, China. surgeon_lin6@163.com
Telephone: +86-510-87971283 Fax: +86-510-87928726
Received: May 6, 2014
Revised: June 25, 2014
Accepted: August 13, 2014
Published online: December 21, 2014
Processing time: 227 Days and 23.6 Hours
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 (I2 = 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: Protective stoma; Low anterior resection; Rectal cancer; Complication; Meta-analysis

Core tip: The use of a protective stoma is an effective application that can reduce the rate of anastomotic leakage in patients who receive low anterior resection for rectal cancer. The morbidity associated with protective stomas and the complications of stoma closure are negligible compared with the reoperations required for anastomosis leakage in the absence of a protective stoma. Therefore, the presence of a non-functioning stoma can be useful for patients undergoing rectal surgery and is recommended during low anterior resections for rectal cancer.