Long-term efficacy of transanal local excision versus total mesorectal excision after neoadjuvant treatment for rectal cancer: A meta-analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
03
04
2023
accepted:
02
11
2023
medline:
22
11
2023
pubmed:
20
11
2023
entrez:
20
11
2023
Statut:
epublish
Résumé
The purpose of this meta-analysis is to compare the long-term efficacy of transanal local excision (TLE) versus total mesorectal excision (TME) following neoadjuvant therapy for rectal cancer. The Web of Science, Pubmed, Medline, Embase, and the Cochrane Library were systematically searched for correlational research. The Newcastle-Ottawa Scale and the Cochrane risk of bias tool were used to assess the quality of cohort studies (CSs) and randomized controlled trials (RCTs), respectively. Statistically analyzed using RevMan5.4. A total of 13 studies, including 3 randomized controlled trials (RCTs) and 10 cohort studies (CSs), involving 1402 patients, were included in the analysis. Of these, 570 patients (40.66%) underwent TLE, while 832 patients (59.34%) underwent TME. In the meta-analysis of CSs, no significant difference was observed between the TLE group and TME group regarding 5-year overall survival (OS) and 5-year disease-free survival (DFS) (P > 0.05). However, the TLE group had a higher rates of local recurrence (LR) [risk ratio (RR) = 1.93, 95%CI (1.18, 3.14), P = 0.008] and a lower rates of 5-years local recurrence-free survival (LRFS) [hazard ratio (HR) = 2.79, 95%CI (1.04, 7.50), P = 0.04] compared to the TME group. In the meta-analysis of RCTs, there was no significant difference observed between the TLE group and TME group in terms of LR, 5-year OS, 5-year DFS, and 5-year disease-specific survival (P > 0.05). After undergoing neoadjuvant therapy, TLE may provide comparable 5-year OS and DFS to TME for rectal cancer. However, neoadjuvant therapy followed by TLE may has a higher LR and lower 5-year LRFS compared to neoadjuvant therapy followed by TME, so patients should be carefully selected. Neoadjuvant therapy followed by TLE may be a suitable option for patients who prioritize postoperative quality of life. However, the effectiveness of this approach requires further research to draw a definitive conclusion.
Identifiants
pubmed: 37983236
doi: 10.1371/journal.pone.0294510
pii: PONE-D-23-09876
pmc: PMC10659211
doi:
Types de publication
Systematic Review
Meta-Analysis
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0294510Informations de copyright
Copyright: © 2023 Lei et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Medicine (Baltimore). 2016 May;95(20):e3718
pubmed: 27196490
J Gastrointest Surg. 2011 Apr;15(4):637-43
pubmed: 21327977
Ann Surg Oncol. 2014 Oct;21(11):3598-607
pubmed: 24802909
Dis Colon Rectum. 2014 Jun;57(6):790-9
pubmed: 24807605
BMJ. 2017 Sep 21;358:j4008
pubmed: 28935701
Acta Oncol. 2016;55(4):502-8
pubmed: 26406287
Colorectal Dis. 2010 Oct;12(10):977-86
pubmed: 19438885
Colorectal Dis. 2020 Dec;22(12):1999-2007
pubmed: 32813899
J Gastroenterol Hepatol. 2022 Aug;37(8):1426-1433
pubmed: 35614027
Int J Colorectal Dis. 2015 Jan;30(1):19-29
pubmed: 25367179
Dis Colon Rectum. 2005 Jul;48(7):1380-8
pubmed: 15906120
Dis Colon Rectum. 2022 Nov 1;65(11):1306-1315
pubmed: 35067503
Dis Colon Rectum. 2016 Apr;59(4):255-63
pubmed: 26953983
Strahlenther Onkol. 2001 Dec;177(12):681-2
pubmed: 11789409
N Engl J Med. 2004 Oct 21;351(17):1731-40
pubmed: 15496622
Surg J (N Y). 2021 Sep 14;7(3):e241-e250
pubmed: 34541316
BJS Open. 2021 May 7;5(3):
pubmed: 34097005
Arch Surg. 1998 Aug;133(8):894-9
pubmed: 9711965
Surg Endosc. 2013 Dec;27(12):4469-77
pubmed: 24057070
Br J Surg. 2018 Oct;105(11):1510-1518
pubmed: 29846017
J Gastrointest Surg. 2012 Dec;16(12):2280-7
pubmed: 23070621
Arch Surg. 2007 Jul;142(7):649-55; discussion 656
pubmed: 17638803
Int J Surg. 2019 Apr;64:62-63
pubmed: 30822524
Lancet Gastroenterol Hepatol. 2020 May;5(5):465-474
pubmed: 32043980
Medicine (Baltimore). 2019 Aug;98(35):e16614
pubmed: 31464897
Colorectal Dis. 2014 Sep;16(9):703-9
pubmed: 24787457
Surg Today. 1993;23(10):860-6
pubmed: 8298229
JAMA. 2000 Aug 23-30;284(8):1008-15
pubmed: 10944647
Int J Colorectal Dis. 2021 Nov;36(11):2375-2386
pubmed: 34244857
Surg Endosc. 2019 Mar;33(3):941-948
pubmed: 30421081
Surg Endosc. 2004 Feb;18(2):281-9
pubmed: 14691716
Ann Surg. 2023 Jan 1;277(1):e96-e102
pubmed: 34225302
Eur J Surg Oncol. 2009 Dec;35(12):1280-5
pubmed: 19487099
Ann Surg Oncol. 2016 Dec;23(13):4302-4309
pubmed: 27489059
Colorectal Dis. 2011 Feb;13(2):e14-9
pubmed: 20860716
Int J Radiat Oncol Biol Phys. 2018 Jul 1;101(3):630-639
pubmed: 29678529
Ann Surg Oncol. 2015 Nov;22(12):3873-80
pubmed: 26198074
Lancet Gastroenterol Hepatol. 2021 Feb;6(2):92-105
pubmed: 33308452
Int J Colorectal Dis. 2019 Dec;34(12):2129-2136
pubmed: 31724079
Radiology. 2013 Oct;269(1):101-12
pubmed: 23801777
Br J Surg. 2012 Sep;99(9):1211-8
pubmed: 22864880
Cir Esp. 2016 Mar;94(3):137-43
pubmed: 26796026
Eur J Surg Oncol. 2009 Oct;35(10):1071-7
pubmed: 19364631
Int J Colorectal Dis. 2022 Sep;37(9):1997-2011
pubmed: 35960389
Surg Endosc. 2006 Aug;20(8):1203-7
pubmed: 16703429
Surg Endosc. 2016 Jan;30(1):307-14
pubmed: 25907863
BMJ. 2021 Mar 29;372:n160
pubmed: 33781993
Cancer Res Treat. 2018 Jul;50(3):634-645
pubmed: 28675024
Clin Transl Oncol. 2009 Jul;11(7):460-4
pubmed: 19574204
World J Surg. 2008 Aug;32(8):1776-82
pubmed: 18560934
Int J Radiat Oncol Biol Phys. 2017 Sep 1;99(1):136-144
pubmed: 28816139
Dis Colon Rectum. 2016 Oct;59(10):984-97
pubmed: 27602930
Asian J Surg. 2006 Oct;29(4):227-32
pubmed: 17098653