Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer

Abstract

Background: A defunctioning stoma is frequently created to minimize the impact of any subsequent anastomotic leak after a low rectal anastomosis. This review evaluates the need for routine stoma formation. Methods: A meta‐analysis was performed of randomized controlled trials (RCTs) and non‐randomized studies with an interventional group evaluating the need for a defunctioning stoma after low anterior resection for rectal cancer. Primary outcomes analysed included clinical anastomotic leak rate, reoperation rate and mortality related to leak. Results: Four RCTs and 21 non‐randomized studies, with 11 429 patients in total, were analysed. Meta‐analysis of the RCTs showed a lower clinical anastomotic leak rate (risk ratio (RR) 0·39 (95 per cent c.i. 0·23 to 0·66); P < 0·001) and a lower reoperation rate (RR 0·29 (0·16 to 0·53); P < 0·001) in the stoma group. Meta‐analysis of the non‐randomized studies showed a lower clinical anastomotic leak rate (RR 0·74 (0·67 to 0·83); P < 0·001), lower reoperation rate (RR 0·28 (0·23 to 0·35); P < 0·001) and lower mortality rate (RR 0·42 (0·28 to 0·61); P < 0·001) in the stoma group. Conclusion: A defunctioning stoma decreases clinical anastomotic leak rate and reoperation rate. It is recommended after low anterior resection for rectal cancer. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.