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Meta-Analysis
. 2015 Jan;21(1):19-27.
doi: 10.1007/s12253-014-9863-x. Epub 2014 Nov 28.

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

Xiao-Tong Wang  1 , De-Gang Li, Lei Li, Fan-Biao Kong, Li-Ming Pang, Wei Mai
Affiliations
Meta-Analysis

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

Xiao-Tong Wang et al. Pathol Oncol Res. 2015 Jan.

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.

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Figures

Fig. 1
Fig. 1
Flowchart of the search process
Fig. 2
Fig. 2
Forest plot of RR for 5-year survival, local recurrence, CRM and complication among included studies. A. results of the meta-analysis on 5-year survival. B. results of the meta-analysis on local recurrence. C. results of the meta-analysis on CRM. D. results of the meta-analysis on complication
Fig. 3
Fig. 3
Funnel plot of studies to detect publication bias
See this image and copyright information in PMC

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