Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

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 (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. 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.

Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases

“…One of the most feared complications after colorectal surgery is anastomotic leakage, with a reported incidence of between 1% and 19% . A diverting ileostomy has been shown to reduce symptomatic anastomotic leakage, but it still remains a serious complication with extensive consequences .…”

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

“…Several studies in the past have found that the rate of anastomotic leakage was not reduced by the construction of defunctioning proximal stoma [11, 13, and 18]. However, couple of recent meta-analyses have shown that defunctioning proximal stoma significantly reduces the incidence as well as the consequences of the anastomotic leakage [19,20]. In this study, rates of anastomotic leakage were higher when defunctioning proximal stoma was not constructed (14.9 % vs 6.2 %) though it did not reach statistical significance (p = 0.068).…”

The use of preventive stomas in surgical treatment of colorectal cancer

“…Ряд авторов считает, что превентивные стомы «защищают» первичный анастомоз и предотвращают его несостоятельность [13,14]. В то же время большин-ство исследований убедительно свидетельствуют о том, что превентивные стомы не снижают частоту несосто-ятельности первичных анастомозов, но уменьшают ее проявления, что снижает частоту осложнений, требу-ющих оперативного лечения [2,15,16].…”

“…В настоящее время их формируют при низких и ультранизких резекциях прямой кишки с тотальной мезоректумэктомией. Однако зачастую хирург при принятии решения о формировании пре-вентивной стомы руководствуется собственным опы-том и тактиками, принятыми в клинике [2,3,9,14].…”

“…В связи с этим все чаще ставится вопрос о пока-заниях к формированию превентивных стом и необхо-димости их применения в лечении колоректального рака [6,8,9]. Наиболее остро этот вопрос встал с вне-дрением в медицинскую практику лапароскопических вмешательств и современных сшивающих аппаратов, которые позволяют формировать ультранизкие (ниже 6 см от аноректальной линии) анастомозы [10][11][12][13][14][15]. В настоящее время нет четких показаний к формиро-ванию превентивных стом при резекции прямой киш-ки: в основном хирург руководствуется собственным опытом и традициями, принятыми в клинике [16][17][18][19][20][21].…”