Therapeutic effect of extralevator abdominoperineal excision in combination with conventional abdominoperineal excision on distal rectal cancer: A Meta-analysis

Objective: To explore the short and long-term efficacy of extralevator abdominoperineal excision (ELAPE) vs. conventional abdominoperineal excision (APE) on distal rectal cancer. Methods: Relevant studies were identified by search of Medline, EMBASE, and Web of Science published between January 1, 2008 and February 28, 2015, and included in the systematic review and meta-analysis with Stata software (version 12.0). Results: Our Meta-analysis included 14 studies involving 3 278 patients, of whom 1843 (56.2%) underwent ELAPE and 1 435 (43.8%) underwent APE. Compared with patients undergoing APE, those undergoing ELAPE had a significantly reduced risk of intraoperative bowel perforation (IBP) involvement (OR=0.55, 95% CI= 0.37-0.85), but no significant reduction in the occurrence of CRM positivity (OR=0.81, 95% CI=0.52-1.25), local recurrence (LR) (OR=0.49, 95% CI=0.18-1.30), wound complications (WCs) (OR=0.93, 95% CI= 0.65-1.35) or in-hospital death (IHD) (OR=0.89, 95% CI=0.47-1.71). Conclusion: ELAPE can reduce the risk of IBP but not for CRM positivity or LR when compared with APE. Therefore, more higher-quality studies are needed to verify the short- and long-term effects of ELAPE procedure on distal rectal cancer.