Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: A systematic review and meta-analysis

BackgroundLong-course chemoradiotherapy (LCRT) with delayed surgery or short-course radiotherapy (SCRT) with immediate surgery is probably the most frequent regimen in the treatment of rectal cancer. Debate is still going on whether SCRT or LCRT is more effective. So we performed this meta-analysis to evaluate the safety and efficacy of SCRT with immediate surgery versus LCRT with delayed surgery for the management of rectal cancer.MethodsLiterature were searched from PubMed, Embase, Web of science, Cochrane Library up to May, 2014. Quality of the randomized controlled trials (RCTs) was evaluated according to the Cochrane's risk of bias tool of RCT. RevMan 5.3 was used for statistical analysis. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated. Subgroup analysis and sensitivity analysis were employed to explore heterogeneity.Results16 trials were included in the qualitative systematic review. 12 trials were included in meta-analyses. 4 of them were RCTs; other 8 were non-RCTs. Meta-analysis demonstrated that there were no significant differences in overall survival (OS), disease free survival (DFS), local recurrence rate (LRR), distant metastasis rate (DMR), sphincter preservation rate, R0 resection rate and late toxicity. Compared with SCRT, LCRT obviously increased pCR rate [RR = 0.15, 95%CI (0.08, 0.28), P = 0.003], while LCRT obviously increased the grade 3–4 acute toxicity [RR = 0.13, 95%CI (0.06, 0.28), P < 0.00001].ConclusionsSCRT with immediate surgery is as effective as LCRT with delayed surgery for treatment of rectal cancer in terms of OS, DFS, LRR, DMR, Sphincter preservation rate, R0 resection rate and late toxicity. Though LCRT increased pCR rate, LCRT also increased acute toxicity compared with SCRT. SCRT is a better choice in centers with a long waiting list or lack of medical resources.     

微创DHS与LCP治疗高龄股骨粗隆间骨折的比较研究

目的比较研究微创行DHS与LCP治疗高龄股骨粗隆间骨折的疗效。方法回顾性分析微创行DHS及LCP内固定治疗高龄股骨粗隆间骨折58例,男26例,女32例;年龄70～102岁,平均年龄78.0岁。结果 DHS组28例,手术时间平均70min(60～90min);LCP组30例,手术时间平均55min(40～90min),两组差异有统计学意义(P0.01)。术中出血:DHS组平均出血100ml(50～300ml);LCP组平均70ml(50～150ml),两组差异有统计学意义(P0.01)。58例伤口均一期愈合。院内死亡1例,7例失访。50例获得6个月～3年的随访(平均16个月)。骨折愈合时间:DHS组10～16周,平均12周;LCP组10～12周,平均10.4周,两组差异有统计学意义(P0.05)。按照黄公怡等的评价标准:DHS组优良率87.5%,LCP组优良率95%,两组差异有统计学意义(P0.05)。结论微创行DHS与LCP内固定治疗高龄股骨粗隆间骨折都具有创伤小、固定稳定、骨折易愈合等优点,微创LCP钢板固定手术更容易操作,出血少,是更值得提倡的一种手术方法。     

微创锁定加压钢板治疗高龄股骨转子间骨折

目的:探讨微创锁定加压钢板(locking compression plate,LCP)治疗高龄股骨转子间骨折的疗效.方法:2007年8月至2009年1月微创LCP内固定治疗高龄股骨转子间骨折28例,男13例,女15例;年龄70～102岁,平均78.6岁.受伤到手术时间3～8 d,平均4.5 d.结果:手术时间40～90 min,平均55 min;术中出血50～150 ml,平均70 ml.住院期间死亡1例.25例获得随访,时间6个月～2年,平均15个月.骨折愈合时间10～12周,平均10.4周.按照黄公怡等的评价标准:优20例,良4例,差1例.结论:微创LCP内固定治疗高龄股骨转子间骨折具有方法简单、固定稳定、出血少等优点,是值得提倡的一种手术方法.