Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials

Low anterior resection (LAR) with colorectal or coloanal anastomosis for mid to distal rectal cancer less than 10 cm from the anal verge is associated with a higher risk of anastomotic leak compared to high anterior resection and restorative colonic procedures (1). LAR is associated with higher rates of morbidity and mortality including re-operations, wound infection, conversion to permanent stoma, stenosis and recurrence (1-3). Until recently, there has not been a predictor of anastomotic leak post LAR, but there is now a model based on mass nationwide data that calculates the risk of anastomotic leakage post LAR (4). In general, the Cochrane review in 2011 reported the rate of anastomotic leak following LAR to be 8.8% (38/431) without mechanical bowel preparation (MBP) and 10.4% (43/415) with bowel preparation (5)