To compare the safety and efficacy between extraperitoneal colostomy and intraperitoneal colostomy in laparoscopic abdominoperineal resection (LAPR) for rectal cancer through meta-analysis, and to determine the most suitable way of permanent colostomy for patients with rectal cancer.

Chinese and English databases such as PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI and Wanfang database were searched. The clinical research on the treatment of rectal cancer by LAPR extraperitoneal stoma and intraperitoneal stoma published in China and abroad from October 2008 to March 2020 was collected. The qualified literatures were selected by two researchers according to the inclusion and exclusion criteria, Newcastle-Ottawa Scale (NOS)was used to evaluate the quality of the Non-randomized controlled studies and the score more than 5 points was the inclusion criteria, and the randomized control study (RCT) was evaluated with Jadad scale. The basic information of literature and related outcome indicators were extracted, and the data were brought into meta-analysis by Revman 5.3 software.

A total of 14 studies involving 1 210 patients(594 patients in the extraperitoneal stoma group and 616 patients in the intraperitoneal stoma group), including 9 clinical control studies and 5 randomized control studies, the results of meta-analysis showed that compared with the laparoscopic intraperitoneal stoma, the incidence of extraperitoneal stoma parastomal hernia (OR=0.14, 95% CI: 0.08~0.25; P<0.00001), the incidence of stoma prolapse (OR=0.15, 95% CI: 0.06~0.37; P<0.0001), the incidence of stoma retraction (OR=0.24, 95% CI: 0.09~0.63; P=0.004) were significantly reduced,the postoperative hospital stay was shortened (MD=-0.82, 95% CI: -0.97~-0.68; P<0.00001), and the first exhaust time was advanced (MD=-0.71, 95% CI: -0.88~-0.54; P<0.00001), the sense of defecation was more easily obtained (OR=9.67, 95% CI: 4.40~21.23; P<0.00001), but the incidence of stoma edema was significantly increased (OR=1.81, 95% CI: 1.13~2.92; P=0.01), while the incidence of stoma stenosis (OR=0.62, 95% CI: 0.25~1.50; P=0.29), the incidence of stoma infection (OR=0.57, 95% CI: 0.29~1.12; P=0.10) and the time of stoma (MD=-0.94, 95% CI: -5.69~-3.81; P=0.70), there were no significant differences.

Laparoscopic abdominoperineal resection combined with extraperitoneal colostomy can significantly reduce the incidence of complications related to colostomy, accelerate the recovery of patients, more easily obtain the sense of defecation, and have a certain degree of safety and effectiveness. It is suggested that extraperitoneal colostomy should be the first choice for LAPR permanent colostomy for rectal cancer.