Purpose

The management of early-stage rectal cancer in clinical practice is controversial. The aim of this network meta-analysis was to compare oncological and postoperative outcomes for T1T2N0M0 rectal cancers managed with local excision in comparison to conventional radical resection.

Methods

A systematic review of Medline, Embase and Cochrane electronic databases was performed. Relevant studies were selected using PRISMA guidelines. The primary outcomes measured were 5-year local recurrence and overall survival. Secondary outcomes included rates of postoperative complication, 30-day mortality, positive margin and permanent stoma formation.

Results

Three randomized controlled trials and 27 observational studies contributed 8570 patients for analysis. Radical resection was associated with reduced 5-year local recurrence in comparison to local excision. This was statistically significant in comparison to trans-anal local excision (odds ratio (OR) 0.23; 95% confidence interval 0.16–0.30) and favourable in comparison to endoscopic techniques (OR 0.40; 95% confidence interval 0.13–1.23) although this did not reach clinical significance. Positive margin rates were lowest for radical resection. However, 30-day mortality rates, perioperative complications and permanent stoma rates all favoured local excision with no statistically significant difference between endoscopic and trans-anal techniques.

Conclusion

Radical resection of early rectal cancer is associated with the lowest 5-year local recurrence rates and the lowest rate of positive margins. However, this must be balanced with its higher 30-day mortality and complication rates as well as the increased risk of permanent stoma. The emerging potential role of neoadjuvant therapy prior to local resection, and the heterogeneity of its use, as an alternative treatment for early rectal cancer further complicates the treatment paradigm and adds to controversy in this field.

中文翻译：

---

内镜和经肛门局部切除与根治性切除治疗早期直肠癌的系统评价和网络荟萃分析

目的

早期直肠癌的治疗在临床实践中存在争议。该网络荟萃分析的目的是比较局部切除与传统根治性切除治疗的 T1T2N0M0 直肠癌的肿瘤学和术后结果。

方法

对 Medline、Embase 和 Cochrane 电子数据库进行了系统评价。使用 PRISMA 指南选择相关研究。测量的主要结果是 5 年局部复发率和总生存率。次要结局包括术后并发症发生率、30 天死亡率、切缘阳性和永久性造口形成。

结果

三项随机对照试验和 27 项观察性研究贡献了 8570 名患者进行分析。与局部切除相比，根治性切除可减少 5 年局部复发。与经肛门局部切除术（比值比 (OR) 0.23；95% 置信区间 0.16–0.30）相比，这具有统计学意义，并且与内窥镜技术相比（OR 0.40；95% 置信区间 0.13–1.23）有利，尽管这确实达不到临床意义。根治性切除术的阳性切缘率最低。然而，30 天死亡率、围手术期并发症和永久性造口率均倾向于局部切除，内镜技术和经肛门技术之间没有统计学上的显着差异。

结论

早期直肠癌根治术与最低的 5 年局部复发率和最低的切缘阳性率相关。然而，这必须与其较高的 30 天死亡率和并发症发生率以及永久性造口风险增加相平衡。局部切除前新辅助治疗的潜在作用以及其使用的异质性，作为早期直肠癌的替代治疗，进一步使治疗模式复杂化，并增加了该领域的争议。