Sui Qiaoqi, Lin Junzhong, Peng Jianhong, Zhao Yujie, Deng Yuxiang, Pan Zhizhong
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine Guangzhou.
J Cancer. 2017 Oct 23;8(19):3969-3974. doi: 10.7150/jca.21476. eCollection 2017.
To date, there is not enough evidence concerning the optimal treatment strategy for early rectal carcinoids, we conducted a meta-analysis in order to determine the feasible local treatment for these selected patients. : We searched the studies from the PubMed, Cochrane database, Medline, Ovid, SpringerLink, PMC and Embase between January 2007 and April 2017. Studies of local surgical excision compared with endoscopic resection for rectal carcinoids less than 20mm without adverse features were included. Data were analyzed by using Stata SE 12.0. Seven studies were included in this meta-analysis, with a total of 1056 patients. The data showed that local surgical excision was associated with higher complete resection rate than that of endoscopic resection (OR 5.837, 95%CI 2.048 to 16.632, P=0.001) but consuming longer procedural time (SMD 1.757, 95% CI 1.263 to 2.251, P=0.000). Additionally, incidences of recurrence and en bloc resection rate were comparable between two kinds of resections. The difference of post-operative complications remained unclear. For rectal carcinoids sized 20mm or smaller without adverse features, endoscopic resection might be an efficient treatment, which achieved a comparable oncological safety as local surgical excision.
迄今为止，关于早期直肠类癌的最佳治疗策略尚无足够证据，我们进行了一项荟萃分析，以确定针对这些特定患者可行的局部治疗方法。我们检索了2007年1月至2017年4月期间来自PubMed、Cochrane数据库、Medline、Ovid、SpringerLink、PMC和Embase的研究。纳入了对无不良特征的直径小于20mm的直肠类癌进行局部手术切除与内镜切除相比较的研究。使用Stata SE 12.0对数据进行分析。该荟萃分析纳入了7项研究，共1056例患者。数据显示，局部手术切除的完全切除率高于内镜切除（比值比5.837，95%置信区间2.048至16.632，P = 0.001），但手术时间更长（标准化均值差1.757，95%置信区间1.263至2.251，P = 0.000）。此外，两种切除方式的复发率和整块切除率相当。术后并发症的差异仍不明确。对于直径20mm或更小且无不良特征的直肠类癌，内镜切除可能是一种有效的治疗方法，其肿瘤学安全性与局部手术切除相当。
