Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067, Dresden, Germany.
Int J Colorectal Dis. 2011 Oct;26(10):1227-40. doi: 10.1007/s00384-011-1235-3. Epub 2011 May 21.
After introduction of total mesorectal excision (TME) as the gold standard for rectal cancer surgery, oncologic results appeared to be inferior for abdominoperineal excision (APE) as compared to anterior resection. This has been attributed to the technique of standard APE creating a waist at the level of the tumor-bearing segment. This systematic review investigates outcome of both standard and extended techniques of APE regarding inadvertent bowel perforation, circumferential margin (CRM) involvement, and local recurrence.
A literature search was performed to identify all articles reporting on APE after the introduction of TME using Medline, Ovid, and Embase. Extended APE was defined as operations that resected the levator ani muscle close to its origin. All other techniques were taken to be standard. Studies so identified were evaluated using a validated instrument for assessing nonrandomized studies. Rates for perforation, CRM involvement, and local recurrence were compared using chi-square statistics.
In the extended group, 1,097 patients, and in the standard group, 4,147 patients could be pooled for statistical analysis. The rate of inadvertent bowel perforation and the rate of CRM involvement for extended vs. standard APE was 4.1% vs. 10.4% (relative risk reduction 60.6%, p = 0.004) and 9.6% vs. 15.4% (relative risk reduction 37.7%, p = 0.022), respectively. The local recurrence rate was 6.6% vs. 11.9% (relative risk reduction 44.5%, p < 0.001) for the two groups.
This systematic review suggests that extended techniques of APE result in superior oncologic outcome as compared to standard techniques.
全直肠系膜切除术（TME）被引入作为直肠癌手术的金标准后，与前切除术相比，腹会阴切除术（APE）的肿瘤学结果似乎较差。这归因于标准 APE 技术在肿瘤载瘤段水平形成“腰部”。本系统评价研究了标准和扩展 APE 技术在意外肠穿孔、环周切缘（CRM）受累和局部复发方面的结果。
使用 Medline、Ovid 和 Embase 进行文献检索，以确定所有报告 TME 引入后 APE 的文章。扩展 APE 被定义为切除靠近起点的肛提肌的手术。所有其他技术都被认为是标准的。使用评估非随机研究的验证工具评估如此确定的研究。使用卡方检验比较穿孔、CRM 受累和局部复发的发生率。
在扩展组中，可对 1097 例患者进行汇总分析，在标准组中，可对 4147 例患者进行汇总分析。意外肠穿孔和 CRM 受累的发生率在扩展与标准 APE 之间分别为 4.1%与 10.4%（相对风险降低 60.6%，p=0.004）和 9.6%与 15.4%（相对风险降低 37.7%，p=0.022）。两组局部复发率分别为 6.6%与 11.9%（相对风险降低 44.5%，p<0.001）。
本系统评价表明，与标准技术相比，APE 的扩展技术可获得更好的肿瘤学结果。
