Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland.
Department of Surgery, School of Medicine and Medical Sciences, University College Dublin, Ireland.
Eur J Surg Oncol. 2021 Sep;47(9):2421-2428. doi: 10.1016/j.ejso.2021.05.011. Epub 2021 May 12.
Management paradigms for tumours from the sigmoid colon to the lower rectum vary significantly. The upper rectum (UR) represents the transition point both anatomically and in treatment protocols. Above the UR is clearly defined and managed as colon cancer and below is managed as rectal cancer. This study compares outcomes between sigmoid, rectosigmoid and UR tumours to establish if differences exist in operative and oncological outcomes.
Electronic databases were searched for published studies with comparative data on peri-operative and oncological outcome for upper rectal and sigmoid/rectosigmoid (SRS) tumours treated without neoadjuvant radiation. The search adhered to PRISMA guidelines (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Data was combined using random-effects models.
Seven comparative series examined outcomes in 4355 patients. There was no difference in ASA grade (OR, 1.28; 95% CI, 0.99-1.67; P = 0.06), T3/T4 tumours (OR, 1.24; 95% CI, 0.95-1.63; P = 0.12), or lymph node positivity (OR, 0.97; 95% CI, 0.70-1.36; P = 0.87). UR cancers had higher rates of operative morbidity (OR, 0.72; 95% CI, 0.55-0.93; P = 0.01) and anastomotic leak (OR, 0.47; 95% CI, 0.31-0.71; P = 0.0004). There was no difference in local recurrence (OR, 0.63; 95% CI, 0.37-1.08; P = 0.10). SRS tumours had lower rates of distant recurrence (OR, 0.83; 95% CI, 0.68-1.0; P = 0.05). Rectosigmoid operative and cancer outcomes were closer to UR than sigmoid.
Based on existing data, UR and rectosigmoid tumours have higher morbidity, leak rates and distant recurrence than more proximal tumours.
乙状结肠至直肠下段的肿瘤管理模式差异很大。直肠上段（UR）在解剖和治疗方案上既是过渡点。UR 以上部分明确界定并作为结肠癌进行治疗，以下部分则作为直肠癌进行治疗。本研究比较了 UR、乙状结肠和直肠乙状结肠（SRS）肿瘤之间的手术和肿瘤学结果，以确定手术和肿瘤学结果是否存在差异。
检索了电子数据库中关于未经新辅助放疗治疗的 UR 和 SRS 肿瘤的围手术期和肿瘤学结果的比较数据的已发表研究。该搜索遵循 PRISMA 指南（系统评价和荟萃分析的首选报告项目）指南。使用随机效应模型合并数据。
7 项比较系列共纳入 4355 例患者，其结果无差异：ASA 分级（OR，1.28；95%CI，0.99-1.67；P=0.06）、T3/T4 肿瘤（OR，1.24；95%CI，0.95-1.63；P=0.12）或淋巴结阳性（OR，0.97；95%CI，0.70-1.36；P=0.87）。UR 癌症的手术发病率更高（OR，0.72；95%CI，0.55-0.93；P=0.01）和吻合口漏（OR，0.47；95%CI，0.31-0.71；P=0.0004）。局部复发率无差异（OR，0.63；95%CI，0.37-1.08；P=0.10）。SRS 肿瘤的远处复发率较低（OR，0.83；95%CI，0.68-1.0；P=0.05）。UR 和直肠乙状结肠的手术和癌症结果比乙状结肠更接近。
根据现有数据，UR 和直肠乙状结肠肿瘤的发病率、漏诊率和远处复发率高于更靠近上段的肿瘤。
