Local resection versus radical resection for early-stage rectal cancer: a systematic review and meta-analysis.

Autor: Tan S; Shaanxi University of Chinese Medicine, Shaanxi, China., Xu C; Fuling Hospital Affiliated to Chongqing University, 2 Gaosuntang Road, Fuling District, Chongqing City, 408099, China., Ma H; Fuling Hospital Affiliated to Chongqing University, 2 Gaosuntang Road, Fuling District, Chongqing City, 408099, China., Chen S; Shaanxi University of Chinese Medicine, Shaanxi, China., Yang Y; Shanghai University of Chinese Medicine, Shanghai, China., Zhan Y; Shaanxi University of Chinese Medicine, Shaanxi, China., Wu J; Shaanxi University of Chinese Medicine, Shaanxi, China., Sun Z; Shaanxi University of Chinese Medicine, Shaanxi, China., Ren B; Shaanxi University of Chinese Medicine, Shaanxi, China., Zhou Q; Fuling Hospital Affiliated to Chongqing University, 2 Gaosuntang Road, Fuling District, Chongqing City, 408099, China. qizhou112@163.com., Cu Y; Department of Anorectal, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, No. 2, Weiyang West Road, Qindu District, Xianyang City, 712099, Shaanxi, China. 913141097@qq.com.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2022 Jul; Vol. 37 (7), pp. 1467-1483. Date of Electronic Publication: 2022 May 27.
DOI: 10.1007/s00384-022-04186-8
Abstrakt: Purpose: The optimal surgical approach for early-stage rectal cancer remains controversial. Radical resection is considered to be the gold standard for rectal cancer treatment. More and more studies show that local resection can replace traditional radical resection in the treatment of early rectal cancer. This research aimed to compare the efficacy of local excision and radical surgery for early-stage rectal cancer and report the evidence-based clinical advantages of both techniques.
Methods: The clinical trials comparing oncological and perioperative local and radical resection outcomes for early-stage rectal cancer were searched from 7 national and international databases.
Results: Finally, 3 randomized controlled trials and 14 cohort studies were included. In terms of oncology and perioperative outcomes, there were no statistically significant differences between the radical resection group and the local resection group in terms of OS (HR = 1.05, 95% CI (0.98, 1.13), DFS [HR = 1.18, 95% CI (0.93, 1.48), p = 0.168), distant metastasis rate (RR = 1.04, 95% CI (0.49, 2.20), p = 0.928), and mortality rate (RR = 1.52, 95% CI (0.80, 2.91), p = 0.200). However, there were significant differences in the outcomes of complications (RR = 2.85, 95% CI (2.07, 3.92), p < 0.001), length of hospital stays (WMD = 5.41, 95% CI (3.94, 6.87), p < 0.001), stoma rate (RR = 7.69, 95% CI (2.39, 24.77), p = 0.001), local recurrence rate (RR = 0.48, 95% CI (0.27, 0.86), p = 0.013), operative time (WMD = 74.68, 95% CI (68.00, 81.36), p < 0.001), blood loss (WMD = 156.36, 95% CI (95.48, 217.21, p < 0.001), and adverse events (RR = 1.59, 95% CI (1.05, 2.41), p = 0.027).
Conclusion: Local excision may be a viable alternative to radical resection for early-stage rectal cancer, but higher quality clinical studies are needed to confirm this.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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