Abdominoperineal Resection is Associated with a Poor Outcome Compared with Anterior Resection for Rectal Cancer: A Meta-Analysis

Background: It's controversies whether Anterior Resection (AR) is superior to Abdominoperineal Resection (APR) for rectal cancer. To solve this question, a meta-analysis was performed. Methods: Studies published from 1990 to May 2014 evaluating outcomes after AR and APR for rectal cancer were identified by an electronic literature search. A meta-analysis was performed to compute Hazard Ratio (HR) along with 95% Confidence Intervals (CI). We extracted HRs of Disease-Free Survival (DFS) and Overall-Survival (OS) compared these two methods using a randomeffects model. Results: Twenty four studies met the inclusion criteria, yielding a total of 21,221 patients. Pooled adjusted HRs were 1.276 (95% CI, 1.266 -1.287) for DFS and 1.130 (95% CI, 1.126-1.133) for OS that compared APR with AR. Sensitivity analyses were performed and APR was still associated with poor prognosis. Conclusion: APR has been associated with poor prognosis compared with AR. While possible, a more radical operation, extralevator abdominoperineal resection should be considered.