Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2015

Open Access 01-12-2015 | Research

Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies

Authors: Wen-long Gu, Sheng-wen Wu

Published in: World Journal of Surgical Oncology | Issue 1/2015

Login to get access

Abstract

Background

Recent studies have shown that a protective stoma can reduce morbidity in low anterior resection for rectal cancer; however, the necessity of it is still controversially discussed.

Methods

We performed this meta-analysis to provide a comprehensive evaluation of the role of defunctioning stoma in low anterior resection for rectal cancer on the rates of anastomotic leakage and reoperation related to leakage with or without defunctioning stoma by calculating the pooled risk ratio.

Results

Studies and relevant literature published between 2004 and 2014 regarding the construction of a protective stoma after low anterior resection were searched though PubMed and EMBASE databases. Finally, a total of 13 studies including 8,002 patients were included in this meta-analysis. The results indicated that protective stomas significantly reduced the rate of postoperative anastomotic leakage and reoperation after low anterior rectal resection. The pooled risk ratios were 0.47 (95% CI: 0.33–0.68, P <0.0001) and 0.36 (95% CI: 028–0.46, P <0.00001), respectively.

Conclusions

The findings from this present meta-analysis suggest that a defunctioning stoma could effectively reduce the clinical consequences of anastomotic leakage and reoperation, it is recommended in patients undergoing low rectal anterior resection for rectal cancer.
Literature
1.
Griffen FD, Knight Sr CD, Whitaker JM, Knight Jr CD. The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg. 1990;211:745–51. Discussion 751–2.PubMedCentralPubMedCrossRef
2.
Kapiteijn E, Putter H, van de Velde CJ, Cooperative investigators of the Dutch ColoRectal Cancer Group. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg. 2002;89:1142–9.PubMedCrossRef
3.
den Dulk M, Noter SL, Hendriks ER, Brouwers MA, van der Vlies CH, Oostenbroek RJ, et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol. 2009;35:420–6.CrossRef
4.
Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11:8–15.PubMedCrossRef
5.
Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H, et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007;94:1548–54.PubMedCrossRef
6.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–51.PubMedCrossRef
7.
Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001;88:400–4.PubMedCrossRef
8.
McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92:1150–4.PubMedCrossRef
9.
Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92:211–6.PubMedCrossRef
10.
Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum. 2005;48:2076–9.PubMedCrossRef
11.
Law WL, Chu KW, Choi HK. Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision. Br J Surg. 2002;89:704–8.PubMedCrossRef
12.
Hallbook O, Matthiessen P, Leinskold T, Nystrom PO, Sjodahl R. Safety of the temporary loop ileostomy. Colorectal Dis. 2002;4:361–4.PubMedCrossRef
13.
Bakx R, Busch OR, Bemelman WA, Veldink GJ, Slors JF, van Lanschot JJ. Morbidity of temporary loop ileostomies. Dig Surg. 2004;21:277–81.PubMedCrossRef
14.
Laurent C, Nobili S, Rullier A, Vendrely V, Saric J, Rullier E. Efforts to improve local control in rectal cancer compromise survival by the potential morbidity of optimal mesorectal excision. J Am Coll Surg. 2006;203:684–91.PubMedCrossRef
15.
Kaiser AM, Israelit S, Klaristenfeld D, Selvindoss P, Vukasin P, Ault G, et al. Morbidity of ostomy takedown. J Gastrointest Surg. 2008;12:437–41.PubMedCrossRef
16.
van Westreenen HL, Visser A, Tanis PJ, Bemelman WA. Morbidity related to defunctioning ileostomy closure after ileal pouch-anal anastomosis and low colonic anastomosis. Int J Colorectal Dis. 2012;27:49–54.PubMedCentralPubMedCrossRef
17.
Cipe G, Erkek B, Kuzu A, Gecim E. Morbidity and mortality after the closure of a protective loop ileostomy: analysis of possible predictors. Hepatogastroenterology. 2012;59:2168–72.PubMed
18.
19.
Beirens K, Penninckx F. Procare: defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of Procare. Acta Chir Belg. 2012;112:10–4.PubMed
20.
Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, et al. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology. 2008;55:1562–7.PubMed
21.
Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN, Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis. 2005;7:51–7.PubMedCrossRef
22.
Gong H, Yu Y, Yao Y. Clinical value of preventative ileostomy following ultra-low anterior rectal resection. Cell Biochem Biophys. 2013;65:491–3.PubMedCrossRef
23.
Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Erenler I, Erdamar S. Evaluation of diverting ileostomy in laparoscopic low anterior resection for rectal cancer. Asian J Surg. 2011;34:63–8.PubMedCrossRef
24.
Lefebure B, Tuech JJ, Bridoux V, Costaglioli B, Scotte M, Teniere P, et al. Evaluation of selective defunctioning stoma after low anterior resection for rectal cancer. Int J Colorectal Dis. 2008;23:283–8.PubMedCrossRef
25.
Ma CC, Wu SW. Retrospective analysis of protective stoma after low anterior resection for rectal cancer with total mesorectal excision: three-year follow-up results. Hepatogastroenterology. 2013;60:420–4.PubMed
26.
Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:462–9.PubMedCrossRef
27.
Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.PubMedCentralPubMedCrossRef
28.
Nurkin S, Kakarla VR, Ruiz DE, Cance WG, Tiszenkel HI. The role of faecal diversion in low rectal cancer: a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma. Colorectal Dis. 2013;15:e309–16.PubMedCrossRef
29.
Seo SI, Yu CS, Kim GS, Lee JL, Yoon YS, Kim CW, et al. The role of diverting stoma after an ultra-low anterior resection for rectal cancer. Ann Coloproctol. 2013;29:66–71.PubMedCentralPubMedCrossRef
30.
Shiomi A, Ito M, Saito N, Hirai T, Ohue M, Kubo Y, et al. The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers. Colorectal Dis. 2011;13:1384–9.PubMedCrossRef
31.
Ulrich AB, Seiler C, Rahbari N, Weitz J, Buchler MW. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52:412–8.PubMedCrossRef
32.
Marusch F, Koch A, Schmidt U, Geibetaler S, Dralle H, Saeger HD, et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum. 2002;45:1164–71.PubMedCrossRef
33.
Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46:653–60.PubMedCrossRef
34.
Poon RT, Chu KW, Ho JW, Chan CW, Law WL, Wong J. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg. 1999;23:463–7. Discussion 467–468.PubMedCrossRef
35.
Jestin P, Pahlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case–control study. Colorectal Dis. 2008;10:715–21.PubMedCrossRef
36.
Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92:1137–42.PubMedCrossRef
37.
Tsunoda A, Tsunoda Y, Narita K, Watanabe M, Nakao K, Kusano M. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum. 2008;51:218–22.PubMedCrossRef
38.
Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Jarvinen HJ. A randomised study of colostomies in low colorectal anastomoses. Eur J Surg. 1997;163:929–33.PubMed
Metadata
Title
Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies
Authors
Wen-long Gu
Sheng-wen Wu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2015
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-014-0417-1

Other articles of this Issue 1/2015

World Journal of Surgical Oncology 1/2015 Go to the issue

Research

Better operative outcomes achieved with the prone jackknife vs. lithotomy position during abdominoperineal resection in patients with low rectal cancer

Research

Ten-year surgical experiences with penile cancer at a tertiary care hospital in northwestern Tanzania: a retrospective study of 236 patients

Research

mRNA expression of somatostatin receptor subtypes SSTR-2, SSTR-3, and SSTR-5 and its significance in pancreatic cancer

Case report

A case of marginal zone B cell lymphoma mimicking IgG4-related dacryoadenitis and sialoadenitis

Research

Surveillance for early stages of colon cancer: potentials for optimizing follow-up protocols

Research

Macro- and microscopic findings of ICG fluorescence in liver tumors