[Meta-analysis comparing long-term outcomes of intersphincteric resection versus abdominoperineal resection for low rectal cancer].

Objective: To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. Methods: We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Results: Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, P=0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, P<0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, P<0.01). In contrast, there were no statistically significant differences between the two groups in gender (P=0.78), body mass index (P=0.77), or pathological N stage (P=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, P=0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, P<0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, P=0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, P<0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, P=0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, P=0.55) did not differ significantly between the two groups. Conclusion: ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.目的： 比较经括约肌间切除术（ISR）与经腹会阴联合切除术（APR）治疗低位直肠癌的长期疗效。 方法： 采取Meta分析方法检索2005年1月至2023年1月期间Pubmed、Medline、EMBASE和Cochrane、中国知网（CNKI）、中国生物医学文献数据库、维普数据库中，比较ISR与APR治疗低位直肠癌的文献，选择符合准入标准的文献提取数据进行分析。纳入标准：（1）2023年1月之前所有比较ISR和APR治疗低位直肠癌的文献；（2）文献类型为前瞻性随机对照研究或设计良好的队列研究；排除无法获得全文的、重复发表或缺少主要结局指标、数据不详以及违反统计学计算原则的文献。主要结局指标包括：术后并发症发生率、5年总生存率（OS）、5年无病生存率（DFS）、5年无局部复发率（LRF）。术后并发症定义为术后30 d内发生的Clavien-Dindo 2级以上的并发症。次要指标包括：手术时间和住院时间。 结果： 总计16篇文献、2 498例患者被纳入本研究。与APR组相比，ISR组的患者相对较年轻（WMD=-1.82，95%CI=-2.94~-0.70，P=0.01），肿瘤距肛缘距离较远（WMD=0.43，95%CI=0.18~0.67，P<0.01），病理T分期较低（T3~4期：OR=0.54，95%CI=0.36~0.81，P<0.01）。而两组在性别（P=0.78）、体质指数（P=0.77）、病理N分期（P=0.09）上，差异没有统计学意义。与APR组相比，ISR组患者术后并发症发生率较低（OR=0.77，95%CI=0.60~0.99，P=0.04），住院时间较短（WMD=-4.30，95%CI=-7.07~-1.53，P<0.01），5年OS（HR=0.54，95%CI=0.33~0.88，P=0.01）和5年DFS（HR=0.65，95%CI=0.47~0.90，P<0.01）均较高。两组5年LRF（HR=0.66，95%CI=0.40~1.10，P=0.11）以及手术时间（WMD=-9.71，95%CI=-41.89~22.47，P=0.55）的差异均无统计学意义。 结论： 对于分期较早的低位直肠癌，ISR可以作为APR安全有效的替代。.