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

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 c...

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Published in:International journal of colorectal disease 2022-07, Vol.37 (7), p.1467-1483
Main Authors: Tan, Shufa, Xu, Chenxi, Ma, Hongbo, Chen, Shikai, Yang, Yunyi, Zhan, Yanrong, Wu, Jiyun, Sun, Zhenfu, Ren, Bozhi, Zhou, Qi, Cu, Yaping
Format: Article
Language:English
Subjects:
Analysis
Cancer
Care and treatment
Clinical trials
Colorectal cancer
Evidence-based medicine
Gastroenterology
Health aspects
Hepatology
Internal Medicine
Medicine
Medicine & Public Health
Meta-analysis
Metastases
Metastasis
Oncology, Experimental
Proctology
Rectum
Review
Statistical analysis
Surgery
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Summary: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  
ISSN:1432-1262
0179-1958
1432-1262
DOI:10.1007/s00384-022-04186-8