| Objective : To explore and discuss the safety and efficacy of extralevator abdominoperineal excision(ELAPE)versus conventional abdominoperineal resection(CAPR)for low local rectum cancer.Methods:We searched through the major medical databases such as Pubmed,Medline,Cochrane library,Embase,WOS-SCI,Chinese Bio-medicine Database,CNKI,VIP database for all published studies without any limit on language from establishment until January 2017,to collect the clinical studies of ELAPE and CAPR.The collected literature was screened by two independent researchers based on inclusion and exclusion criteria,After extracting the relevant data and evaluating the quality of the included literature,meta analysis was performed using Review Manager 5.3 software.Results:Thirteen studies(3597patients)were inclouded.2050 patients in the ELAPE group and 1547 patients in the CAPR group,and there are not statistically differences between groups in CRM(OR=0.64,95%CI=0.33-1.24,P=0.19)and lymph nodes harvested(MD=0.40,95%CI=-0.33-1.13,P=0.28)and the rate of LR(OR=0.45,95%CI=0.14-1.44,P=0.18)between ELAPE and CAPR.There are not statistically differences between groups in the rate of perineal herniation(OR=1.15,95%CI=0.53-2.51,P=0.72)and wound infection(OR=1.32,95%CI=0.86-2.02,P=0.21)and intestinal obstruction(OR=3.75,95%CI=0.75-18.79,P=0.11).Compared with CAPR,ELAPE can reduce intraoperative blood loss(MD=-55.25,95%CI=-78.46--32.04,P<0.00001),decrease the rate of IOP(OR=0.64,95%CI=0.41-0.99,P=0.04)and R0 resection(OR=0.39,95%CI=0.26-0.60,P=0.0001).ELAPE can increase the rate of perineal pain(OR=2.89,95%CI=1.52-5.47,P=0.001)and urinary retention(OR=2.00,95%CI=1.03-3.90,P=0.04)Conclusion:The current evidence shows that ELAPE can reduce intraoperative blood loss and decrease the rate of IOP.But can not decrease the rate of CRM,LR,perineal herniation,wound infection,intestinal obstruction,R0 resection and can not increase lymph nodes harvested. |
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