title: [Advantage of extralevator abdominoperineal excision comparing to the conventional abdominoperineal excision for low rectal cancer: a Meta-analysis].
abstract: Whether extralevator abdominoperineal excision (ELAPE) improves survival and safety remains controversial. Systematic review of all comparative studies to define the superiority of ELAPE to conventional abdominoperineal excision (APE).  Methods: Corresponding data, with case-control studies or cohorts regarding intraoperative perforation rate, the local recurrence rate and postoperative complications in the ELAPE group and the APE group, were retrieved from PubMed, Embase, the Cochrane Library, Chinese Biomedical Literature (CMB), VIP, China National Knowledge Infrastructure (CNKI), and Wanfang Database. Meta-analysis was performed by using RenMan 5.2.  Results: A total of 10 articles were included. Intraperative perforation rate (MD=0.54, 95% CI 0.31 to 1.39, P=0.03), local recurrence rate (MD=0.30, 95% CI 0.21 to 0.42, P<0.001) in the ELAPE group was significantly lower than that in the APE group. The difference in positive margin rate between the 2 groups was not statistically significant (P=0.07).  Conclusion: Through gap repair of episiotomy and individualized therapy can improve ELAPE postoperative quality of life. ELAPE shows certain advantages in treating lower rectal cancer comparing to APE, but it should pay attention to individualized treatment. More studies through large sample multi-center, medium and long term randomized design are necessary to determine the effect of surgery on tumor.
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330000, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330000, China.
authors.forename: Chengwen
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330000, China.
authors.forename: Jiajia
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330000, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Ren
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330000, China.
authors.forename: Jiaqing
authors.initials: J
authors.lastname: Cao
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D002681:China; D013505:Digestive System Surgical Procedures; D004841:Episiotomy / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D009364:Neoplasm Recurrence, Local; D010502:Perineum / Q000601:surgery*; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*