Meta-analysis of oncological outcome after abdominoperineal resection or low anterior resection for lower rectal cancer.

Xiao-Tong Wang,Fan-Biao Kong,Wei Mai,Li-Ming Pang,De-Gang Li,Lei Li

doi:10.1007/s12253-014-9863-x

Abstract

In lower rectal cancer, postoperative outcome is still subject of controversy between the advocates of abdominoperineal resection (APR) and low anterior resection (LAR). Reports suggest that low anterior resection may be oncologically superior to abdominoperineal excision, although no good evidence exists to support this. Publications were identified which assessed the differences comparing 5-year survival, local recurrence, circumferential resection margin rate, complications and so on. A meta-analysis was performed to clarify the safety and feasibility of the two procedures with several types of outcome measures. A total of 13 studies met the inclusion criteria, and comprised 6,850 cases. Analysis of these data showed that LAR group was highly correlated with 5-year survival (pooled OR = 1.73, 95%CI: 1.30–2.29, P = 0.0002 random-effect). And local recurrence rate of APR group was significantly higher than that in LAR group (pooled OR = 0.63, 95%CI: 0.53–0.75, P < 0.00001 fixed-effect). Also, the circumferential resection margin (CRM) were high involved in APR group than in LAR group. (5 trials reported the data, pooled OR = 0.43, 95%CI: 0.36–0.52, P < 0.00001 fixed-effect). Besides, the incidents of overall complications of APR group was higher compared with LAR group (pooled OR = 0.52, 95%CI: 0.29–0.92, P = 0.03 random-effect). Patients treated by APR have a higher rate of CRM involvement, a higher local recurrence, and poorer prognosis than LAR. And there is evidence that in selected low rectal cancer patients, LAR can be used safely with a better oncological outcome than APR. due to the inherent limitations of the present study, for example, the trails available for this systematic review are limited and the finite retrospective data, future prospective randomized controlled trials will be useful to fully investigate these outcome measures and to confirm this conclusion.

Highlights

Colorectal carcinoma is the fourth most common malignancy worldwide
The major sphincter-saving operation (SSO) low anterior resection (LAR) is more common than abdominoperineal resection (APR) in the treatment of rectal cancer. rectal cancer patients preferred LAR to APR as it avoided the requirement for a permanent stoma, despite the fact that LAR was associated with a risk of postoperative complications including fecal incontinence [1]
There were significant numbers of patients who do not agree to the treatment with permanent iliac colostomy

Summary

Introduction

Colorectal carcinoma is the fourth most common malignancy worldwide. The major sphincter-saving operation (SSO) low anterior resection (LAR) is more common than abdominoperineal resection (APR) in the treatment of rectal cancer. rectal cancer patients preferred LAR to APR as it avoided the requirement for a permanent stoma, despite the fact that LAR was associated with a risk of postoperative complications including fecal incontinence [1]. The major sphincter-saving operation (SSO) low anterior resection (LAR) is more common than abdominoperineal resection (APR) in the treatment of rectal cancer. A number of studies comparing the short-term or long-term outcomes, of LAR vs APR for lower rectal cancer have shown that LAR has become the preferred option in curative surgery [6,7,8,9]. Most studies were too small to adequately evaluate the surgical outcomes For those patients with lower rectal cancer eligible for surgical treatment, whether APR or LAR is the better choice remains controversial [13,14,15]. This article has prompted the present comparison of the operative results and oncologic outcomes of those patients treated by LAR and APR. We performed a meta-analysis of all the studies directly comparing APR and LAR in the treatment of low rectal cancer. We performed a meta-analysis of all the studies directly comparing APR and LAR in the treatment of low rectal cancer. these results may help to determine that the selected surgical procedure, either LAR of APR, is performed safely

Methods

Results

Conclusion