Cao K, Jin Y, Shi B H, Shi X Y, Wang Z J, Han J G
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jun 25;26(6):595-602. doi: 10.3760/cma.j.cn441530-20230315-00083.
To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, =0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, <0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, <0.01). In contrast, there were no statistically significant differences between the two groups in gender (=0.78), body mass index (=0.77), or pathological N stage (=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, =0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, <0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, =0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, <0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, =0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, =0.55) did not differ significantly between the two groups. ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.
比较括约肌间（经内括约肌和外括约肌）切除术（ISR）和腹会阴联合直肠切除术（APR）治疗低级别直肠癌的长期疗效。我们采用荟萃分析方法比较这些手术。检索了2005年1月至2023年1月期间发表在PubMed、Medline、EMBASE、Cochrane、中国知网（CNKI）、中国生物医学文献数据库和Vipers数据库中比较ISR和APR治疗低位直肠癌的报告，并选择符合纳入标准的报告进行数据提取和分析。纳入标准如下：（1）2023年1月前所有比较ISR和APR治疗低位直肠癌的报告；（2）前瞻性随机对照研究或设计良好的队列研究。排除标准如下：（1）无全文；（2）重复发表、缺少主要结局指标和数据不明；（3）无效的统计分析。本研究纳入了16项研究，共2498例患者。与APR组相比，ISR组患者相对年轻（加权均数差[WMD]=-1.82，95%CI=-2.94至-0.70，P=0.01），肿瘤距肛缘更远（WMD=0.43，95%CI=0.18至0.67，P<0.01），病理T分期更低（T3-4期：OR=0.54，95%CI=0.36至0.81，P<0.01）。相比之下，两组在性别（P=0.78）、体重指数（P=0.77）或病理N分期（P=0.09）方面无统计学显著差异。与APR组相比，ISR组患者术后并发症发生率更低（OR=0.77，95%CI=0.60至0.99，P=0.04），住院时间更短（WMD=-4.30，95%CI=-7.07至-1.53，P<0.01），5年总生存率更高（HR=0.54，95%CI=0.33至0.88，P=0.01），5年无病生存率更高（HR=0.65，95%CI=0.47至0.90，P<0.01）。两组在5年局部区域复发率（HR=0.66，95%CI=0.40至1.10，P=0.11）和手术时间（WMD=-9.71，95%CI=-41.89至22.47，P=0.55）方面无显著差异。对于早期低级别直肠癌，ISR是APR的一种安全有效的替代方法。
