O'Brien Luke, Morarasu Stefan, Morarasu Bianca Codrina, Neary Paul C, Musina Ana Maria, Velenciuc Natalia, Roata Cristian Ene, Dimofte Mihail Gabriel, Lunca Sorinel, Raimondo Diego, Seracchioli Renato, Casadio Paolo, Clancy Cillian
Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland.
2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.
Int J Colorectal Dis. 2023 Feb 27;38(1):55. doi: 10.1007/s00384-023-04352-6.
The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection.
The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes.
Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable.
Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.
目前尚不清楚切除结直肠子宫内膜沉积物的最佳手术方法。对结直肠沉积物进行刮除和盘状切除可保留器官，但存在复发风险，并伴有相关功能问题及再次手术的风险。根治性切除有潜在更高并发症的风险，但可能与较低的复发率相关。本荟萃分析比较了保守手术（刮除和盘状切除）与结直肠根治性切除之间的围手术期和长期结局。
该研究已在国际前瞻性系统评价注册库（PROSPERO）登记。对PubMed和EMBASE数据库进行了系统检索。纳入了所有比较接受保守手术与结直肠切除治疗直肠子宫内膜沉积物患者手术结局的对比研究。在三个主要变量组中比较了两个主要组（保守组与切除组），包括组间可比性、手术结局和长期结局。
分析了17项研究，共2861例患者，患者按手术方式分为：结直肠切除（n = 1389）、刮除（n = 703）和盘状切除（n = 742）。当将结直肠根治性切除与保守手术进行比较时，复发风险较低（p = 0.002），功能结局相当（轻度低位前切除综合征，p = 0.30；重度低位前切除综合征，p = 0.54），术后漏（p = 0.22）、盆腔脓肿（p = 0.18）和直肠阴道瘘（p = 0.92）的发生率相似。亚组分析显示，刮除的复发率最高（p = 0.0007），但造口形成率较低（p < 0.00001），直肠狭窄发生率较低（p = 0.01）。盘状切除和根治性切除相当。
与刮除相比，结直肠切除的复发率显著更低。盘状切除与根治性切除在并发症或功能结局方面无差异，且复发率相似。
