目的:确定直肠冲洗在预防根治性切除术后远端结直肠癌局部复发中的有效性。
方法:在对MEDLINE进行文献检索后,进行了系统评价和荟萃分析,EMBASE,世界卫生组织国际临床试验注册平台(WHOICTRP),ClinicalTrials.gov,和ISRCTN注册表。该研究使用PRISMA指南报告。主要终点是远端结肠癌和直肠癌手术后局部复发的发生率。
结果:筛选后,确定了8项研究,总样本量为6739名患者。在5年的随访中,清除组(WO)的局部复发率为6.08%,无清除组(NWO)的局部复发率为9.48%(OR0.63,95%CI=0.51~0.78,Chi2=6.76,df=7,p=0.45).相对风险降低为36.9%。为了排除36.9%的相对风险从9.48降低到6.08%,具有5%的显着性水平和80%的功效,随机对照试验将需要1946名参与者的总样本量在两个治疗组之间平均分配。
结论:建议在左侧和直肠肿瘤切除中使用直肠冲洗是安全的。在结直肠手术中,这是一个简单而安全的步骤,似乎可以改善长期的肿瘤学结果,并且没有报告与任何并发症相关。
OBJECTIVE: To determine the effectiveness of rectal washout in preventing local recurrence of distal colorectal cancer following curative resection.
METHODS: A systematic review and meta-analysis was performed after a literature search was conducted on MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the ISRCTN registry. The study was reported using PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after distal colonic and rectal cancer surgery.
RESULTS: After screening, 8 studies with a total sample size of 6739 patients were identified. At 5-year follow-up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51-0.78, Chi2 = 6.76, df = 7, p = 0.45). The relative risk reduction was 36.9%. To exclude a 36.9% relative risk reduction from 9.48 to 6.08% with a 5% significance level and 80% power a randomized control trial would require a total sample size of 1946 participants distributed equally between the two treatment arms.
CONCLUSIONS: It is safe to recommend the use of rectal washout for left sided and rectal tumour resections. It is a simple and safe step during colorectal surgery that appears to improve long-term oncological outcomes and was not reported to be associated with any complications.