Miles术与Dixon术治疗低位直肠癌的Meta分析

Meta-analysis of oncological outcomes after abdominoperineal resection vs low anterior resection for lower rectal cancer

目的:对于低位直肠癌的患者,在腹会阴联合直肠癌根治术(Miles手术)与经腹直肠癌切除术(Dixon手术)两种术式之间选择最适术式存在一个很大的争议.本文旨在从循证医学角度为选择上述两种术式提供询证依据.方法:利用美国国立医学图书馆(Medline)、荷兰医学文摘(Embase)、医学生物中心(BioMed Central)、中国知网(CNKI)、万方数据(Wangfang)及中国生物医学文献数据库(CBM)等数据库搜索报道比较两种术式的5年生存率、局部复发率、CRM及术后并发症的发生率的文献,从而比较两种术式的安全性、可行性及最优性.结果:共有11篇文献符合要求,其中包括6544例手术.分析显示D i x o n术的5年生存率更高(pooled RR=1.18,95%CI:1.08-1.30,P<0.00001 random-effect),Miles术却伴随着更高的局部复发率(pooled RR=0.67,95%CI:0.57-0.78,P<0.00001 fixed-effect)、CRM(4trials reported the data,pooled RR=0.49,95%CI:0.38-0.62,P<0.00001 random-effect)及术后并发症(pooled RR=0.60,95%CI:0.38-0.93,P=0.02 random-effect).结论:Miles术后的患者局部复发率、CRM及并发症高于Dixon术后的患者,且行Miles术的患者肿瘤预后也不及选择Dixon术的患者.因此对于低位直肠癌的患者,Dixon术应优先考虑.

AIM： To compare the oncologica! outcome ot abdominoperineal resection （APR） and low an- terior resection （LAR） for lower rectal cancer. METHODS： Publications that compared 5-year survival, local recurrence, circumferential resec- tion margin （CRM） involvement rate, and com- plications were identified by literature search. A meta-analysis was performed to clarify the safety and feasibility of the two procedures with regards to several types of outcome measures. RESULTS： A total of 11 studies met the inclu-sion criteria, including 6544 cases. Analysis of these data showed that the LAR group was associated with a higher 5-year survival rate （pooled RR = 1.18, 95%Ch 1.08-1.30, P 〈 0.00001, random-effect）. Local recurrence rate （pooled RR = 0.67, 95%CI： 0.57-0.78, P 〈 0.00001, fixed-effect） and CRM involvement rate （4 trials reported the data, pooled RR = 0.49, 95%CI： 0.38-0.62, P 〈 0.00001, random-effect） were significantly higher in the APR group than in the LAR group. Besides, the incidence of overall complications in the APR group was significantly higher than that in the LAR group （pooled RR = 0.60, 95%CI： 0.38-0.93, P = 0.02, random-effect）. CONCLUSION： Patients treated by APR have a higher rate of CRM involvement, higher local recurrence, and poorer prognosis than those by LAR. When performed with appropriate skill, LAR can be used safely with a better oncological outcome.