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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Meta-analysis of the colon J-pouch vs transverse coloplasty pouch after anterior resection for rectal cancer

C Liao, F Gao, Y Cao, A Tan, X Li, and D Wu.

Review published: 2010.

CRD summary

This review found that the transverse colonic pouch was associated with a similar efficacy and safety profile as the colonic J-pouch in patients who had undergone anterior resection surgery for rectal cancer. The authors' conclusions should be regarded with some caution given the small size of the included trials and limitations in review methods and reporting.

Authors' objectives

To evaluate clinical and safety outcomes with the use of the colonic J-pouch compared with the transverse coloplasty pouch after anterior resection for rectal cancer.

Searching

MEDLINE, EMBASE, the Cochrane Library, and the Chinese databases VIP and CNKI were searched up to 31 October 2008 for relevant studies and abstracts; search terms were reported. Reference lists from selected articles were checked to identify additional references. There were no language restrictions.

Study selection

Randomised controlled trials (RCTs) that compared the use of the colonic J-pouch with the transverse coloplasty pouch in patients who had undergone anterior resection for rectal cancer were eligible for inclusion. Trials had to report functional or safety outcomes of interest to the authors.

In included trials, the mean age of the patients ranged from 50 to 68.3 years (range 23 to 84). Where reported, the operative time ranged from 110 to 250 minutes, and postoperative stay in hospital was from eight to 19 days (range six to 42 days). The distal tumour distance ranged from 2.5 to 12cm. The height of anastomosis ranged from 1.5 to 9cm (where reported). The outcomes evaluated were functional outcomes (including stool frequency and fragmentation) and anorectal physiology outcomes (including resting and squeeze pressures, and rectal volumes). Postoperative outcomes were evaluated at six and 12 months post-surgery. Adverse events were also evaluated.

The authors did not state how many reviewers performed the study selection.

Assessment of study quality

The methodological quality of the trials was assessed using the Jadad 5-point scale for randomisation, concealment, blinding and follow-up.

The authors did not state how many reviewers performed quality assessment.

Data extraction

Two reviewers independently extracted data to calculate odds ratios (OR) for dichotomous data and mean differences for continuous data, with 95% confidence intervals (CI) calculated for each summary estimate. The authors of included trials were contacted for further information if necessary. Any disagreements between the reviewers were resolved by consensus.

Methods of synthesis

Pooled odd ratios, weighted mean differences (WMDs) and 95% confidence intervals for the summary estimates were calculated using a fixed-effect model. Statistical heterogeneity was evaluated using the Cochran's Q-statistic. If statistical heterogeneity was present, the results were summarised using a DerSimonian and Laird random-effects model.

Subgroup and sensitivity analyses were planned to examine potential sources of heterogeneity.

Results of the review

Six RCTs (n=648 patients) were included in the review. Sample sizes in the trials ranged from 30 to 268 patients. The median Jadad score was 2.5 points: three trials scored 3 points; one trial scored 2 points; and two trials scored 1 point. Randomisation was described in four trials. Three trials described drop-outs and withdrawals.

Early postoperative outcomes: There were no statistically significant differences between the treatments in the occurrence of early postoperative events of anastomotic leakage, chest infection, wound infection, anastomotic stricture or fistula.

Functional outcomes: At six months follow-up, there was a statistically significant benefit observed with the transverse coloplasty pouch for nocturnal leakage (OR 5.88, 95% CI 1.22, 28.55; two trials, n=118), but there were no statistically significant differences in stool frequency and stool fragmentation. There was no statistically significant heterogeneity for these functional outcomes.

At 12 months follow-up, the use of the transverse coloplasty pouch was found to be significantly associated with benefits in stool frequency (WMD -0.39, 95% CI -0.50 to -0.29; two trials, n=118). There were no differences between treatments for stool fragmentation or nocturnal leakage. There was no statistical heterogeneity.

Anorectal physiology: There were no significant differences at six months follow-up in resting pressure, squeeze pressure, rectal threshold, and maximal (neo) rectal volume. At 12 months, there were significant differences favouring the colonic J-pouch in maximal rectal volume (WMD -15.02mL, 95% CI -24.85 to -5.19), with no significant heterogeneity. There were no other differences in outcomes between the pouch types for anorectal physiology at 12 months follow-up, although statistical heterogeneity was present across most of these outcomes. There were discrepancies in reporting between the text and tables for maximal rectal volume at 12 months.

Authors' conclusions

The transverse colonic pouch was associated with a similar efficacy and safety profile as the colonic J-pouch in patients with rectal cancer who had undergone anterior resection.

CRD commentary

The review addressed a clear question and criteria for the inclusion of studies were stipulated. Appropriate databases were searched with no language restriction and attempts were made to identify abstracts. Steps were taken to minimise errors and bias for data extraction, but were not reported for study selection and quality assessment.

Although the authors provided the Jadad scores for the quality assessment, there was no information provided on the losses to follow-up. Also there was no information provided on whether any trials used intention-to-treat analyses. Heterogeneity was present for many of the outcomes; planned analyses to investigate sources of heterogeneity were not conducted because of the small number of included trials. This made it difficult to make a judgement on the appropriateness of statistically pooling the results of the trials. The included trials were small and the Jadad scores indicated that they were of poor to moderate quality.

The authors' conclusions were based on the evidence presented, but should be regarded with some caution because of some limitations in the review methods and reporting, and the small size of the included trials.

Implications of the review for practice and research

Practice: The authors stated that, although similar efficacy and adverse event profiles were observed in the trials, there were some advantages of the transverse coloplasty pouch because of the simpler technique of pouch formation and the ability to fashion a pouch in all patients including those with extensive colonic fat and a narrow pelvis.

Research: The authors did not state any implications for research.

Funding

Not stated.

Bibliographic details

Liao C, Gao F, Cao Y, Tan A, Li X, Wu D. Meta-analysis of the colon J-pouch vs transverse coloplasty pouch after anterior resection for rectal cancer. Colorectal Disease 2010; 12(7): 624-631. [PubMed: 19555386]

Indexing Status

Subject indexing assigned by NLM

MeSH

Anastomosis, Surgical; Colonic Pouches; Humans; Proctocolectomy, Restorative /methods; Rectal Neoplasms /surgery; Reoperation

AccessionNumber

12010007765

Database entry date

07/02/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19555386

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