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; I2=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; I2=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; I2=0%; P<0.00001). No significant difference was found in terms of leak-related 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.
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; I2=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; I2=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; I2=0%; P<0.00001). No significant difference was found in terms of leak-related 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.
Authors: E Kapiteijn; C A Marijnen; I D Nagtegaal; H Putter; W H Steup; T Wiggers; H J Rutten; L Pahlman; B Glimelius; J H van Krieken; J W Leer; C J van de Velde Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Rolf Sauer; Heinz Becker; Werner Hohenberger; Claus Rödel; Christian Wittekind; Rainer Fietkau; Peter Martus; Jörg Tschmelitsch; Eva Hager; Clemens F Hess; Johann-H Karstens; Torsten Liersch; Heinz Schmidberger; Rudolf Raab Journal: N Engl J Med Date: 2004-10-21 Impact factor: 91.245
Authors: Kay T Choy; Tze Wei Wilson Yang; Alexander Heriot; Satish K Warrier; Joseph C Kong Journal: Int J Colorectal Dis Date: 2021-01-30 Impact factor: 2.571
Authors: Peter Tschann; Markus P Weigl; Philipp Szeverinski; Daniel Lechner; Thomas Brock; Stephanie Rauch; Jana Rossner; Helmut Eiter; Paolo N C Girotti; Tarkan Jäger; Jaroslav Presl; Klaus Emmanuel; Alexander De Vries; Ingmar Königsrainer; Patrick Clemens Journal: Langenbecks Arch Surg Date: 2022-07-18 Impact factor: 2.895
Authors: Sameh Hany Emile; Sualeh Muslim Khan; Zoe Garoufalia; Emanuela Silva-Alvarenga; Rachel Gefen; Nir Horesh; Michael R Freund; Steven D Wexner Journal: J Gastrointest Surg Date: 2022-08-01 Impact factor: 3.267
Authors: Vera E M Grupa; Hidde M Kroon; Izel Ozmen; Sergei Bedrikovetski; Nagendra N Dudi-Venkata; Ronald A Hunter; Tarik Sammour Journal: Colorectal Dis Date: 2021-03-18 Impact factor: 3.788
Authors: M Wierdak; M Pisarska-Adamczyk; M Wysocki; P Major; K Kołodziejska; M Nowakowski; T Vongsurbchart; M Pędziwiatr Journal: Tech Coloproctol Date: 2020-11-07 Impact factor: 3.781