The Application Value Of Defunctioning Stoma In Sphincter-preserving Surgery For Low Rectal Cancer

Objective:To investigate the application value of defunctioning stoma in sphincter-preserving surgery for low rectal cancer by meta-analysis.Methods:A systematic search of electronic databases including PubMed、Embase、Medline、CBM、CNKI、Wanfang was performed to identify related literatures about the application value of defunctioning stoma in sphincter-preserving surgery for low rectal cancer including randomized controlled trials and non randomized controlled trials.The data was extracted from qualified literature and were analyzed by revman5.3software.The incidence of anastomotic leakage and the rate of the reoperation and mortality related anastomotic leakage occurred were analyzed in randomized controlled trials and non randomized controlled trials.Results:Through careful review,it was finally included in 34 required research literature,14617 patients altogether,including 4 randomized controlled studies,30 non randomized controlled studies.Meta-analysis of randomized controlled trials showed that the incidence of anastomotic leakage was significantly decreased(RR=0.32,95%CI:0.20-0.50,P<0.00001)in defunctioning stoma group and the rate of reoperation after anastomotic leakage occurred was decreased significantly(RR=0.25,95%CI:0.14-0.46,P<0.00001).Meta-analysis of non randomized controlled trials showed a lower clinical anastomotic leakage rate(OR=0.59,95%CI:0.45-0.77,P=0.0002),lower reoperation rate(OR=0.29,95%CI:0.23-0.36,P<0.00001).The lower mortality rate related anastomotic leakage(OR=0.52,95%CI:0.31-0.88,P=0.02)in defunctioning stoma group.Conclusion: A defunctioning stoma in sphincter-preserving surgery for low rectal cancer decreased clinical anastomotic leakage rate and reoperation rate,the mortality rate related anastomotic leakage also lower.However,the quality of the literature included in this article is different,and this result is still required to be further verified by a multi center large sample randomized controlled trial.