Meta-analysis Of Sphincter- Preserving Operation And Abdominoperineal Resection For The Outcomes Difference Of Low Rectal Cancer

Objective To compare the postoperative outcome of sphincter- preserving operation( SPO) and abdominoperineal resection( APR) for low rectal cancer.Methods We retrieved the databases of Pub Med, Embase, the Cochrane library,Wanfang, CNKI. From 2004 to 2014, Publications on comparision between SPO and APR in the treatment of low rectal cancer were searched, the data from the publications were matched with the SPO group and the APR group respectively according to its corresponding surgical resection.The data on postoperative complications, recurrence and5-year survival rate were meta-analyzed.Results In the related databases, eighteen references on 4389 patients were included in this study, two of which were the randomized controlled trials, the other sixteen were retrospective studies.The results showed that: 1. There were no significant statistical difference in the postoperative complications(OR=0.72, 95%CI:0.47- 1.12, P > 0.05).but the SPO group were lower than the APR group for postoperative abdominal infection and uroschesis; 2. In SPO group, 176 of 1595 patients were recurred, and 137 of 1048 patients were recurred in APR group. There was no significant statistical difference in recurrence(OR=0.83, 95%CI:0.65- 1.07, P > 0.05). 3. In SPO group, 1617 of 2250 patients were survived, but 972 of 1449 patients were survived in APR group. There was significant statistical difference in the 5-year survival rate( OR=1.48, 95%CI:1.32- 1.66, P <0.05).The sphincter-preserving operation group was higher than the abdominoperineal resection group in 5-year survival rate.Conclusion In the incidence of postoperative complications,there were no differences between the sphincter- preserving operation and abdominoperineal resection for the low rectal cancer,but the SPO group were lower than the APR group for postoperative abdominal infection and uroschesis. There was no significant statisticaldifference in recurrence,but in 5-year survival rate,the sphincter preservation group was higher than the abdominalperineal resection group. For the patients of low rectal cancer,the sphincter- preserving operation can achieve good results, but in the actual clinical study,we need to consider the patient’s condition to select the appropriate surgical approach.