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Extralevator abdominoperineal excision for low rectal cancer: a systematic review and meta‐analysis of the short‐term outcome
Author(s) -
Zhou X.,
Sun T.,
Xie H.,
Zhang Y.,
Zeng H.,
Fu W.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12921
Subject(s) - medicine , meta analysis , colorectal cancer , abdominoperineal resection , term (time) , outcome (game theory) , oncology , cancer , general surgery , surgery , physics , mathematics , mathematical economics , quantum mechanics
Aim The superiority of extralevator abdominoperineal excision ( ELAPE ) over conventional abdominoperineal excision ( APE ) remains controversial, despite the publication of many studies on this issue. The aim of this meta‐analysis was to provide a clear, evidence‐based comparison of the two procedures. Method A systematic review and meta‐analysis was conducted through a comprehensive search of the PubMed, EMBASE /Medline and Cochrane Central Library databases for all studies comparing ELAPE with conventional APE for low rectal cancer. Pooled data on circumferential resection margin ( CRM ) positivity, intra‐operative bowel perforation, perineal wound complications and local recurrence were analysed. Results Seven studies, involving a total of 2672 patients, were included. Analysis of the pooled data did not reveal a significant difference between the two operations regarding CRM positivity [risk ratio ( RR ) = 0.79, 95% CI : 0.40–1.57; P = 0.50, I 2 = 86%] and perineal wound complications ( RR = 0.91, 95% CI : 0.71–1.16; P = 0.44, I 2 = 49%), and showed a borderline reduced risk of intra‐operative bowel perforation for ELAPE , but still did not reveal a significant difference between the two groups ( RR = 0.61, 95% CI : 0.37–1.00; P = 0.05, I 2 = 58%). Conclusion The current evidence does not indicate a statistically significant superiority of ELAPE over conventional APE in terms of CRM positivity and intra‐operative bowel perforation.