腹会阴联合切除术与低位直肠前切除术治疗极低位直肠癌的疗效比较OACSTPCD

Background The management of very-low rectal cancer is one of the most challenging issues faced by gen-eral and colorectal surgeons.Many feel compelled to pursue abdominoperineal resection(APR)over low anterior resec-tion(LAR)to optimize oncologic outcomes.This study aimed to determine differences in long-term oncologic outcomes between patients undergoing APR or LAR for very-low rectal cancer.Methods The United States Rectal Cancer Consor-tium(2010-2016)was queried for adults who underwent either APR or LAR for stage Ⅰ-Ⅲ rectal cancers＜5 cm from anorectal junction and met inclusion criteria.The primary outcome was disease-free survival.Secondary outcomes in-cluded overall survival,length of stay,complications,recurrence location,and perioperative factors.Results A total of 431 patients with very-low rectal cancer who underwent APR or LAR were identified;154(35.7％)underwent APR.The overall recurrence rate was 19.6％.The median follow-up was 42.5 months.An analysis adjusted for demographics and pathologic stage observed no difference in disease-free survival between operative types(APR-hazard ratio[HR],0.90;95％CI,0.53-1.52;P=0.70).Secondary outcomes demonstrated no significant difference between operation types,includ-ing overall survival(HR,1.29;95％CI,0.71-2.32;P=0.39),complications(OR,1.53;95％CI,0.94-2.50;P=0.12),or length of stay(estimate:0.04,SE=0.25,P=0.54).Conclusion We observed no significant difference in disease-free survival or overall survival between patients undergoing APR or LAR for very-low rectal cancer.This analysis supports the treatment of very-low rectal cancer,without sphincter involvement,by either APR or LAR.