Meta-analysis of extralevator abdominoperineal excision and conventional abdominoperineal excision for low rectal cancer

Abstract

To evaluate the perforation, circumferential resection margin (CRM) and postoperative perineal wound complications after extralevator abdominoperineal excision (ELAPE) and conventional abdominoperineal excision (APE) for low rectal cancer by using systematic review method. The Cochrane Library, PubMed, EMbase, CNKI and VIP database were searched for literatures in which ELAPE and APE were compared for the treatment of low rectal cancer. Meta-analysis was performed to deal with data extracted by Cochrane Systematic Reviews methods. Six studies met the inclusion criteria including one randomized control study and five non-randomized control studies with a total of 656 cases including 346 cases of ELAPE and 310 cases of APE. Meta-analysis showed a lower positive CRM rate (RR=0.48, 95%CI:0.36-0.65) and a lower local recurrence rate (RR=0.43, 95%CI:0.19-0.99) in ELAPE compared with APE. There were no significant differences in operative perforation rate (RR=0.45, 95%CI:0.15-1.37) and post-operative perineal wound complications rate (RR=1.20, 95%CI:0.57-2.50) between the two surgical procedures. ELAPE is associated with lower rates of positive CRM and local recurrence compared with APE.