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Standard versus extralevator abdominoperineal excision and oncologic outcomes for patients with distal rectal cancer: A meta-analysis. | LitMetric

Standard versus extralevator abdominoperineal excision and oncologic outcomes for patients with distal rectal cancer: A meta-analysis.

Medicine (Baltimore)

Department of the Second Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University Department of General Surgery, the Second Affiliated Hospital of Xi'an Medical College Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.

Published: December 2017

AI Article Synopsis

  • - The study investigates the effectiveness of extralevator abdominoperineal excision (ELAPE) for treating distal rectal cancer, which is a debated procedure not commonly used.
  • - An analysis of 17 studies involving 3,479 patients revealed that those who underwent ELAPE had significantly lower risks of local recurrence, mortality, bowel perforation, and positive circumferential resection margins compared to those who had traditional abdominoperineal excision (APE).
  • - The findings suggest that ELAPE is a more effective surgical option than APE, indicating it should be more widely adopted in treating distal rectal cancer.

Article Abstract

Background: The role of extralevator abdominoperineal excision (ELAPE) for distal rectal cancer remains controversial, and the procedure is not widely accepted or practiced.

Methods: An electronic search of Medline, EMBASE, Web of Science, and similar databases for articles in English was performed from the inception of the study until October 31, 2017. Two reviewers extracted information and independently assessed the quality of included studies by the methodological index for nonrandomized studies, then data were analyzed with Review Manager 5.3 software and Stata version 12.0 software.

Results: Our meta-analysis included 17 studies with 3479 patients, of whom 1915 (55.0%) underwent ELAPE and 1564 (44.0%) underwent abdominoperineal excision (APE). Compared with patients undergoing APE, patients undergoing ELAPE had a significant reduced risk of no more than 3 years local recurrence (LR) (risk ratio [RR] = 0.27, 95% confidence interval [CI] = 0.08-0.94), 3-year mortality (odds ratio [OR] = 0.45, 95% CI = 0.20-0.97), intraoperative bowel perforation (IBP) involvement (RR = 0.48, 95% CI = 0.31-0.74), and circumferential resection margin (CRM) positivity (RR = 0.66, 95% CI = 0.43-1.00) at the threshold level.

Conclusions: The application of ELAPE is more effective in reducing the chance of 3 years LR, mortality, IBP involvement and CRM positivity than conventional APE, and worthy of being widely applied in surgical treatment of the distal rectal cancer.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393134PMC
http://dx.doi.org/10.1097/MD.0000000000009150DOI Listing

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