Meta-analysis Of The Value Of Prophylactic Ileostomy In Low Anterior Resection Of Rectal Cancer

Objective:To investigate the efficacy and safety of prophylactic ileostomy in the prevention of anastomotic leakage during low anterior resection of rectal cancer,and to explore the indications of prophylactic ileostomy.Methods:We searched the Cochrane Central,Embase,and PubMed databases for randomized and non-randomized controlled studies published before March 31,2020 on the use of prophylactic ileostomy for the prevention of postoperative anastomotic leakage during low anterior resection of rectal cancer.Randomized controlled studies on prophylactic ileostomy in the prevention of postoperative anastomotic leakage in low anterior resection of rectal cancer from CNKI and Wanfang Medical Network were searched.In order to increase the number of included literatures and maximize the quality of this study,a manual search was also conducted.In the literature included in this study,the type of preventive ostomy was traditional loop ileal ostomy,while the related studies of terminal ileal suspension,self-closing protective ileostomy,and catheter ileostomy through appendiceal stump were excluded.Relevant data indicators from the literatures meeting the inclusion requirements were extracted,and the extracted data were analyzed using RevMan 5.3 line meta-analysis.The incidence of anastomotic leakage and the reoperation rate due to anastomotic leakage in the randomized controlled studies and non-randomized controlled studies were statistically analyzed.In the randomized controlled studies,Chinese and English literatures were grouped into subgroups for analysis.To investigate the efficacy and safety of prophylactic ileostomy in the prevention of anastomotic leakage after operation for rectal cancer,and to discuss the complications related to prophylactic ileostomy.Results:Through the above 5 Chinese and English databases and manual search,A total of 394 literatures were found.Through careful screening,A total of 21 literatures in Chinese and English were finally included.Among them,12 were randomized controlled trials in Chinese and English,4 were RCTs in English and 8 were RCTs in Chinese.Nine non-randomized controlled trials.A total of 3441 patients were enrolled.Meta-analysis showed that the anastomotic leakage rate in the Chinese and English RCTs with prophylactic ileostomy was significantly lower than that in the group without an ileostomy(RR=0.20,95%CI=0.12-0.34,P<0.0001).The incidence of anastomotic leakage in both the English and Chinese subgroups was significantly lower than that in the English subgroup(RR=0.30,95%CI=0.16-0.57,P=0.0002)and the Chinese subgroup(RR=0.12,95%CI=0.05-0.29,P<0.00001).After anastomotic leakage,the rate of requiring resurgical intervention was significantly reduced(RR=0.12,95%CI=0.04-0.40,P=0.0005).The rate of anastomotic leakage was lower in the non-RCT group with prophylactic ileostomy than in the non-RCT group(OR=0.20,95%CI=0.29-0.88,P=0.02),And the rate of secondary operation caused by anastomotic leakage was lower(OR=0.19,95%CI=0.10-0.37,P<0.00001).Conclusion:Preventive ileum colostomy used in resection of low rectal cancer can reduce the incidence of postoperative anastomotic leakage and due to the need of postoperative anastomotic leakage surgical intervention in the incidence of secondary surgery again,its efficacy and safety is good,but its own related complication is more,so the use of preventive ileum colostomy need to weigh up the pros and cons,reasonable use in high-risk patients.