从乙状结肠到直肠下部的肿瘤管理范式差异很大。上直肠(UR)在解剖学和治疗方案中均代表过渡点。UR上方明确定义并管理为结肠癌,下方管理为直肠癌。这项研究比较了乙状结肠,直肠乙状结肠和UR肿瘤,以确定手术和肿瘤学结果是否存在差异。
在电子数据库中搜索已发表的研究,这些研究具有关于未经新辅助放疗治疗的上直肠和乙状结肠/直肠乙状结肠(SRS)肿瘤的围手术期和肿瘤学结果的比较数据。搜索遵循PRISMA指南(系统审查和荟萃分析中的首选报告项目)指南。使用随机效应模型组合数据。
七个比较系列检查了4355例患者的结局。ASA等级没有差异(OR,1.28;95%CI,0.99-1.67;P=0.06),T3/T4肿瘤(或,1.24;95%CI,0.95-1.63;P=0.12),或淋巴结阳性(OR,0.97;95%CI,0.70-1.36;P=0.87)。UR癌症的手术发病率较高(OR,0.72;95%CI,0.55-0.93;P=0.01)和吻合口漏(OR,0.47;95%CI,0.31-0.71;P=0.0004)。局部复发无差异(OR,0.63;95%CI,0.37-1.08;P=0.10)。SRS肿瘤的远处复发率较低(OR,0.83;95%CI,0.68-1.0;P=0.05)。直肠乙状结肠手术和癌症结果比乙状结肠更接近UR。
基于现有数据,UR和直肠乙状结肠肿瘤有较高的发病率,与近端肿瘤相比,泄漏率和远处复发。
Management paradigms for tumours from the sigmoid colon to the lower rectum vary significantly. The upper rectum (UR) represents the transition point both anatomically and in treatment protocols. Above the UR is clearly defined and managed as colon cancer and below is managed as rectal cancer. This study compares outcomes between sigmoid, rectosigmoid and UR tumours to establish if differences exist in operative and oncological outcomes.
Electronic databases were searched for published studies with comparative data on peri-operative and oncological outcome for upper rectal and sigmoid/rectosigmoid (SRS) tumours treated without neoadjuvant radiation. The search adhered to PRISMA guidelines (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Data was combined using random-effects models.
Seven comparative series examined outcomes in 4355 patients. There was no difference in ASA grade (OR, 1.28; 95% CI, 0.99-1.67; P = 0.06), T3/T4 tumours (OR, 1.24; 95% CI, 0.95-1.63; P = 0.12), or lymph node positivity (OR, 0.97; 95% CI, 0.70-1.36; P = 0.87). UR cancers had higher rates of operative morbidity (OR, 0.72; 95% CI, 0.55-0.93; P = 0.01) and anastomotic leak (OR, 0.47; 95% CI, 0.31-0.71; P = 0.0004). There was no difference in local recurrence (OR, 0.63; 95% CI, 0.37-1.08; P = 0.10). SRS tumours had lower rates of distant recurrence (OR, 0.83; 95% CI, 0.68-1.0; P = 0.05). Rectosigmoid operative and cancer outcomes were closer to UR than sigmoid.
Based on existing data, UR and rectosigmoid tumours have higher morbidity, leak rates and distant recurrence than more proximal tumours.