Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.
Surg Innov. 2020 Aug;27(4):392-401. doi: 10.1177/1553350620918414. Epub 2020 May 11.
Abdominoperineal resection (APR) has been the standard surgery for ultra-low rectal cancer for a century. In recent years, intersphincteric resection (ISR) has been increasingly used to avoid the permanent colostomy. Up to now, there is no relevant meta-analysis comparing the clinical efficacy of ISR and APR. This meta-analysis aimed to compare the outcomes of these 2 procedures. . A comprehensive search of online databases was performed on PubMed, EMBASE, and the Cochrane Library to obtain comparative studies of ISR and APR. Then the data from studies that met the inclusion criteria were extracted and analyzed. . A total of 12 studies covering 2438 patients were included. No significant differences were found between ISR and APR in gender, body mass index, distance from tumor to anal edge, operative time, and blood loss. In addition, hospital stay (weighted mean differences = -2.98 days; 95% confidence interval [CI] = -3.54 to -2.43; < .00001) and postoperative morbidity (odds ratio [OR] = 0.76; 95% CI = 0.59 to 0.99; = .04) were significantly lower in ISR group compared with APR group. However, patients who underwent ISR showed lower pathological T-stage (T3T4%, OR = 0.49; 95% CI = 0.28 to 0.86; = .01) and lymph node metastasis rate (OR = 0.77; 95% CI = 0.59 to 1.01; = .06) compared with those who underwent APR. Moreover, oncological outcomes were similar between the 2 groups. . ISR may provide a safe alternative to APR, with shorter hospital stays, lower postoperative morbidity, and similar oncological outcomes. Well-designed randomized controlled trials are needed to confirm and update the findings of this analysis.
经肛门直肠会阴切除术（APR）作为超低位直肠癌的标准手术已经有一个世纪了。近年来，为避免永久性结肠造口术，经括约肌间切除术（ISR）越来越多地被采用。到目前为止，还没有关于 ISR 和 APR 临床疗效的相关荟萃分析。本荟萃分析旨在比较这两种手术的结果。我们在 PubMed、EMBASE 和 Cochrane 图书馆上进行了全面的在线数据库检索，以获得 ISR 和 APR 的比较研究。然后提取并分析符合纳入标准的研究的数据。共纳入了 12 项研究，涵盖了 2438 名患者。ISR 和 APR 两组在性别、体重指数、肿瘤距肛缘的距离、手术时间和出血量方面无显著差异。此外，ISR 组的住院时间（加权均数差=-2.98 天；95%置信区间[CI]=-3.54 至-2.43；<.00001）和术后发病率（比值比[OR]=0.76；95%CI=0.59 至 0.99；=.04）明显低于 APR 组。然而，与 APR 组相比，接受 ISR 的患者病理 T 分期（T3T4%，OR=0.49；95%CI=0.28 至 0.86；=.01）和淋巴结转移率（OR=0.77；95%CI=0.59 至 1.01；=.06）较低。此外，两组的肿瘤学结果相似。ISR 可能为 APR 提供一种安全的替代方法，具有较短的住院时间、较低的术后发病率和相似的肿瘤学结果。需要进行精心设计的随机对照试验来证实和更新本分析的结果。
