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Document type:
journal article 
Author(s):
Hüser, N; Michalski, CW; Erkan, M; Schuster, T; Rosenberg, R; Kleeff, J; Friess, H 
Title:
Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. 
Abstract:
SUMMARY BACKGROUND DATA: The role of a defunctioning stoma in patients undergoing low anterior resection for rectal cancer is still the subject of controversy. Recent studies suggest reduced morbidity after low anterior rectal resection with a defunctioning stoma. METHODS: Retrospective and prospective studies published between 1966 and 2007 were systematically reviewed. Randomized controlled trials (RCTs) comparing anterior resections with or without defunctioning stoma were included in a meta-analysis. The pooled estimates of clinically relevant anastomotic leakages and of reoperations were analyzed using a random effects model (odds ratio and 95% confidence interval, CI). RESULTS: Relevant retrospective single (n = 18) and multicenter (n = 9) studies were identified and included in the systematic review. Analysis of incoherent data of the leakage rates in these nonrandomized studies demonstrated that a defunctioning stoma did not influence the occurrence of anastomotic failure but seemed to ameliorate theconsequences of the leak. Four RCTs were included in the meta-analysis. The odds ratio for clinically relevant anastomotic leakage was 0.32 (95% CI 0.17-0.59), revealing a statistically significant benefit conferred through a defunctioning stoma (Z = 3.65, P = 0.0003). The odds ratio for reoperation because of leakage-caused complications was 0.27 (95% CI 0.14-0.51), with significantly fewer reoperations in patients with a defunctioning stoma (Z = 3.95, P< 0.0001). Overall mortality rates were comparable regardless of the presence of a defunctioning stoma. CONCLUSION: A defunctioning stoma reduces the rate of clinically relevant anastomotic leakages and is thus recommended in surgery for low rectal cancers. 
Journal title abbreviation:
Ann Surg 
Year:
2008 
Journal volume:
248 
Journal issue:
Pages contribution:
52-60 
Language:
eng 
Print-ISSN:
0003-4932 
TUM Institution:
Chirurgiesche Klinik und Poliklinik; r Medizinische Statistik und Epidemiologie