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27.05.2022 | Review

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

verfasst von: Shufa Tan, Chenxi Xu, Hongbo Ma, Shikai Chen, Yunyi Yang, Yanrong Zhan, Jiyun Wu, Zhenfu Sun, Bozhi Ren, Qi Zhou, Yaping Cu

Erschienen in: International Journal of Colorectal Disease | Ausgabe 7/2022

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Abstract

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.
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Metadaten
Titel
Local resection versus radical resection for early-stage rectal cancer: a systematic review and meta-analysis
verfasst von
Shufa Tan
Chenxi Xu
Hongbo Ma
Shikai Chen
Yunyi Yang
Yanrong Zhan
Jiyun Wu
Zhenfu Sun
Bozhi Ren
Qi Zhou
Yaping Cu
Publikationsdatum
27.05.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 7/2022
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-022-04186-8

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