Prévalence et facteurs de risque du syndrome de résection antérieure: Méta-analyse avec analyse en sous-groupes
DOI :
https://doi.org/10.62438/tunismed.v104i05.6646Mots-clés :
Syndrome de résection antérieure basse, Cancer du rectum, Prévalence, Facteurs de risque, Méta-analyseRésumé
Introduction: La prévalence de syndrome de résection antérieur du rectul (LARS) majeur LARS et ses facteurs de risque associés restent variables dans la littérature. Cette méta-analyse visait à évaluer la prévalence globale des LARS majeur et à identifier leurs facteurs prédictifs.
Méthodes: Nous avons réalisé une méta-analyse conformément aux directives PRISMA 2020 et AMSTAR 2 afin d’identifier les études rapportant la prévalence des LARS majeur ou les facteurs de risque associés. Une analyses de sous-groupes ont été utilisées pour expliquer l’hétérogénéité.
Résultats: Au total, 21 études portant sur 3 730 patients ont été incluses. La prévalence de LARS majeur était de 36,8 % (IC à 95 % : 30,1 %-44,0 %), avec un intervalle de prédiction à 95 % de 12,0 %-71,2 %, indiquant une hétérogénéité importante. La localisation de la tumeur à moins de 5 cm de la marge anale(p < 0,001) et la radiochimiothérapie néoadjuvante (p = 0,006) étaient significativement associées à un risque accru de LARS majeur. Aucune association significative n’a été trouvée avec la fuite anastomotique, l’approche chirurgicale ou le moment de la fermeture de la stomie.
Conclusion: Notre méta-analyse a montré une prévalence comparable aux données publiées précédemment. La localisation basse de la tumeur et la radiochimiothérapie néoadjuvante ont été identifiées comme deux facteurs de risque indépendants de LARS majeur. Des essais prospectifs randomisés sont nécessaires pour améliorer la stratification du risque de développement d’un LARS majeur.
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