Hsu Yu-Jen, Yu Zhen-Hao, Jong Bor-Kang, You Jeng-Fu, Yu Yen-Lin, Liao Chun-Kai, Lai Cheng-Chou, Chern Yih-Jong
Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, 33305, Taiwan.
College of Medicine, Chang Gung University, No. 259, Wenhua 1St Rd., Guishan Dist., Taoyuan City, 333323, Taiwan.
Int J Colorectal Dis. 2025 Apr 3;40(1):86. doi: 10.1007/s00384-025-04876-z.
Pelvic exenteration (PE) is a complex surgical procedure used to treat patients with recurrent or locally advanced rectal cancer (LARC) as a final recourse. Thus, minimally invasive surgery (MIS) has emerged as an alternative to the traditional open PE as it may reduce surgical trauma and improve recovery. This meta-analysis compared the clinical outcomes between MIS and open PE in patients with LARC.
A systematic review and meta-analysis were conducted following PRISMA and AMSTAR guidelines. Six retrospective studies comprising 368 patients (179 MIS patients; 189 open patients) were included. Data on operative parameters along with short-term and long-term outcomes, including the 3-year overall (OS) and disease-free survival (DFS), were extracted. Risk ratios (RRs) and odds ratios (ORs) were calculated for binary outcomes, while standardised mean differences (SMDs) were calculated for continuous outcomes. All measures were reported with 95% confidence intervals (CIs) using random-effects models.
MIS was associated with significantly reduced blood loss (standardised mean difference (SMD), - 1.57; 95% CI, - 2.27 to - 0.88; p < 0.00001), shorter hospital stays (SMD, - 6.46; 95% CI, - 12.21 to - 0.71; p = 0.03), and quicker diet resumption (SMD: - 0.79; 95% CI, - 1.36 to - 0.21; p = 0.008) than open PE. MIS was associated with a borderline reduction in total complications (OR, 0.45; 95% CI, 0.20-1.00; p = 0.05) and lower rates of abdominal wound complications (OR, 0.22; 95% CI, 0.11 to 0.45; p < 0.0001). No significant differences were observed in R0 resection rates, major complications, or mortality. For long-term outcomes, MIS demonstrated significantly improved 3-year OS (RR, 1.19; 95% CI, 1.01 to 1.41; p = 0.04), whereas 3-year DFS showed no significant difference (RR, 1.02; 95% CI, 0.79 to 1.41; p = 0.87).
MIS offers significant short-term advantages over open PE, including reduced blood loss, faster recovery, and fewer complications while demonstrating improved 3-year OS. These findings support MIS PE as a safe, effective, and viable option for patients with recurrent or LARC.
盆腔脏器切除术（PE）是一种复杂的外科手术，用于治疗复发或局部晚期直肠癌（LARC）患者，作为最后的治疗手段。因此，微创手术（MIS）已成为传统开放性PE的替代方法，因为它可能减少手术创伤并促进恢复。本荟萃分析比较了LARC患者中MIS和开放性PE的临床结局。
按照PRISMA和AMSTAR指南进行系统评价和荟萃分析。纳入了6项回顾性研究，共368例患者（179例MIS患者；189例开放手术患者）。提取了手术参数以及短期和长期结局的数据，包括3年总生存期（OS）和无病生存期（DFS）。计算二元结局的风险比（RRs）和比值比（ORs），计算连续结局的标准化均数差（SMDs）。所有测量值均使用随机效应模型报告95%置信区间（CIs）。
与开放性PE相比，MIS与显著减少的失血量（标准化均数差（SMD），-1.57；95%CI，-2.27至-0.88；p<0.00001）、更短的住院时间（SMD，-6.46；95%CI，-12.21至-0.71；p=0.03）和更快恢复饮食（SMD：-0.79；95%CI，-1.36至-0.21；p=0.008）相关。MIS与总并发症的边缘性减少（OR，0.45；95%CI，0.20-1.00；p=0.05）和腹部伤口并发症发生率较低（OR，0.22；95%CI，0.11至0.45；p<0.0001）相关。在R0切除率、主要并发症或死亡率方面未观察到显著差异。对于长期结局，MIS显示3年OS显著改善（RR，1.19；95%CI，1.01至1.41；p=0.04），而3年DFS无显著差异（RR，1.02；95%CI，0.79至1.41；p=0.87）。
与开放性PE相比，MIS具有显著的短期优势，包括减少失血量、更快恢复和更少并发症，同时显示3年OS有所改善。这些发现支持MIS-PE作为复发或LARC患者的一种安全、有效且可行的选择。
