This trial failed to demonstrate substantial benefit of a centralized system to provide standardized, telephone follow-up for postoperative patients with colorectal cancer. Future interventions could investigate a more tailored approach.

Key Points Question Which approach is best to reduce surgical site infections and anastomotic leak in colorectal surgery: mechanical bowel preparation with oral antibiotics, oral antibiotics only, mechanical bowel preparation only, or no preparation? Findings Among 38 randomized clinical trials (8458 patients) in this network meta-analysis, mechanical bowel preparation with oral antibiotics was associated with the lowest rate of surgical site infections, reducing both incisional and organ/space infections. There was no significant difference in anastomotic leak rate between the 4 approaches. Meaning Mechanical bowel preparation with oral antibiotics is the best approach to reduce surgical site infections in patients undergoing colorectal surgery.

Patients with complex endometriosis of the rectum can be safely managed laparoscopically using a multidisciplinary approach. This case series suggests that a history of rectal pain during defecation that occurs only during menstruation is predictive of females with more extensive rectal disease.

Background: There is a relatively high risk of anastomotic leak in low anterior resection (LAR), associated with significant morbidity and mortality. This systematic review and meta-analysis aims to compare diverting stoma vs. no stoma for LAR in terms of leak rates, reoperations, mortality rates and complication rates. Methods: We systematically performed electronic searches of databases Ovid Medline, PubMed, CCTR, CDSR, ACP Journal Club and DARE from inception to present. Only randomized controlled trials comparing LAR for rectal cancer with versus without stoma diversion were included for analysis. Main outcomes were anastomotic leak, reoperation rate and mortality. Secondary outcomes included other operative and stoma-related complications. Results: Eight randomized controlled trials were included in the study for qualitative and quantitative analyses. A significantly longer operative duration for patients with stoma diversion was seen (WMD 19.50 min; 95% CI: 7.38, 31.63; I 2 =0%, P=0.002). The pooled rate for anastomotic leak was significantly lower for those with stoma diversion (6.3% vs. 18.3%; RR 0.36; 95% CI: 0.24, 0.54; I 2 =0%; P<0.00001). There was lower reoperation rate for patients with stoma diversion compared to no stoma (5.9% vs. 16.7%; RR 0.40; 95% CI: 0.26, 0.60; I 2 =0%; P<0.00001). No significant difference was found in terms of leakrelated mortality between stoma vs. no-stoma cohorts (0.47% vs. 1.0%; P=0.51). Conclusions: The present meta-analysis suggests a diverting or defunctioning stoma following LAR for rectal cancers can reduce anastomotic leak and reoperation rates, without increased risk of mortality or other complications.