A Meta-analysis Of The Comparison Of The Safety And Efficacy Between Extraperitoneal And Traditional Colostomy In Abdominoperineal Resection Of Anorectal Malignant Tumor

Objective:To evaluate the clinical safety and efficacy of extraperitoneal colostomy(ETC)applied in abdominoperineal resection(APR)for anorectal malignant tumor.Methods:Five databases(Pub Med,Cochrane,Embase,CNKI and WAN-FANG)were comprehensively searched(publication dates ranging from 2007 to 2017)for randomized controlled trials(RCT)or controlled clinical trials(CCT)that compared extraperitoneal colostomy(ETC)with intraperitoneal colostomy(ITC)which applied in abdominoperineal resection(APR)for anorectal malignant tumor.We Strictly reviewed the studies according to the inclusion criteria and performed quality assessments.And the data extracted from these trials was analyzed by the Review Manager 5.3 software.Results:1.The basic characteristics of the selected studies: 9 articles were selected at last including 3 English articles 6 Chinese articles.A total of 808 patients were analyzed in the research including 409 cases of extraperitoneal stoma and 399 cases of intraperitoneal stoma.2.Comparison of the total complications after the operations in two groups: ETC group can reduce The morbidity compared to the ITC group.(OR=0.27,95%CI:0.18~0.40;P<0.00001).3.Comparison of the rates of parastomal hernia after the operations in two groups:Compared with the control group,ETC group got lower incidence of parastomal hernia.(OR=0.08,95%CI:0.04-0.20,P<0.00001).4.Comparison of the rates of internal hernia after the operations in two groups: Compared with the control group,ETC group had lower internal hernia rates.(OR=0.16,95%CI:0.04-0.71;P=0.02).5.Comparison of the rates of defaecation sensation in two groups :Compared with the control group,ETC group got better defaecation sensation.(OR=-0.35,95%CI:0.11~1.10;p>0.05).6.Comparison of the rates of prolapse after the operations in two groups: Compare with the control group,ETC group had lower prolapsed rates.(OR=0.29,95%CI:0.10-0.86;P<0.05).7.Comparison of the rates of stoma retraction after the operations in two groups : The difference between the rates of stoma retraction in two groups were not statistically significant(OR=-0.35,95%CI:0.11~1.10;p>0.05).8.Comparison of the rates of blood supply disorder and necrosis after operation in two groups: The difference between the rates of blood supply disorder or necrosis in two groups were not statistically significan(OR=-0.82,95%CI: 0.33-2.04;P>0.05).9.Comparison of the rates of peristomal infecton after the operations in two groups : The difference between the rates of peristomal infecton in two groups were not statistically significant(OR=0.72,95%CI:0.33~1.58;P>0.05).10.Comparison of the Duration of operation in two groups : The duration of operation made no statistical differences between the two groups(WMD=2.27,95%CI:-6.51~11.05;P>0.05).Conclusious:The application of extraperitoneal stoma in abdomino-perineal resection of anorectal malignant tumor can effectively reduce the incidence of parastomal hernia、 internal hernia and stoma prolapse.In addition,Extraperitoneal stoma can make the patient obtain excellent defaecation sensation.The feeling of defecation can help the patients to improve the quality of life.However,There was no significant difference between extraperitoneal and intraperitoneal stoma in terms of infection around the stoma,the blood supply disorder or necrosis of the stoma and the incidence of stoma retraction.From the studies above We conclude that the extraperitoneal colostomy compared to intraperitoneal stoma in abdominal-perineal resection for anorectal malignant tumor have certain advantages,but the study has its’ limitations: most researches included in this study are retrospective clinic trials and the numbers of patients performed extraperitoneal colostomies are not enough.Perfect results must depend on studies of higher quality including multicenter randomized controlled trials with a large number of patients.