Extraperitoneal Colostomy Versus Transperitoneal Colostomy After Laparoscopic Abdominoperineal Resection for Rectal Cancer: A Systematic Review and Meta-analysis.

PURPOSE: This study aimed to compare extraperitoneal colostomy (EPC) with transperitoneal colostomy (TPC) after laparoscopic abdominoperineal resection (APR) for rectal cancer regarding postoperative complications.

METHOD: A literature search was performed on PubMed, Ovid, and Cochrane Databases for studies comparing EPC with TPC after laparoscopic APR for rectal cancer. The last search was performed on June 4, 2024. The primary outcome was the incidence of parastomal hernia. The Review Manager (version 5.3) was used for data analysis.

RESULTS

A total of 9 studies with 1002 patients were included in this meta-analysis. Among the enrolled literatures, one was randomized clinical trials, and others were retrospectively case-control designed. EPC showed significant efficiency in preventing parastomal hernia ( P <0.001, OR=0.16, 95% CI: 0.09-0.28, I2 =0%). Besides, the results indicated that the EPC group was associated with significantly less incidence of stoma retraction ( P =0.02, OR=0.23, 95% CI: 0.06-0.81, I2 =0%), stoma prolapse ( P =0.002, OR=0.18, 95% CI: 0.06-0.54, I2 =0%), and total stoma-related complications ( P <0.001, OR=0.50, 95% CI: 0.33-0.74, I2 =26%). In addition, no significant difference was observed between the 2 groups in terms of the total operative time or the time for colostomy creation.

CONCLUSION

Current data demonstrated the significant efficiency of EPC in preventing parastomal hernia after laparoscopic APR for rectal cancer. Besides, the clinical safety and feasibility of EPC were also indicated. The EPC procedure could be widely recommended for permanent colostomy in clinical practice.