Document Detail

Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer.
MedLine Citation:
PMID:  19358171     Owner:  NLM     Status:  MEDLINE    
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.
W S Tan; C L Tang; L Shi; K W Eu
Publication Detail:
Type:  Evaluation Studies; Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  The British journal of surgery     Volume:  96     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-14     Completed Date:  2009-04-24     Revised Date:  2009-10-28    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  462-72     Citation Subset:  AIM; IM    
Copyright Information:
2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
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MeSH Terms
Anastomosis, Surgical / mortality
Randomized Controlled Trials as Topic
Rectal Neoplasms / mortality,  physiopathology,  surgery*
Surgical Stomas / physiology*
Surgical Wound Dehiscence / surgery
Treatment Outcome
Comment In:
Br J Surg. 2009 Sep;96(9):1094; author reply 1094   [PMID:  19672924 ]
Br J Surg. 2009 Nov;96(11):1374-5; author reply 1375   [PMID:  19847849 ]

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