Department of Colorectal Surgery, The Sixth Affiliated Hospital (Guangdong Gastrointestinal Hospital), Sun Yat-sen University, Guangzhou 510655, People's Republic of China.
Int J Colorectal Dis. 2011 Apr;26(4):415-21. doi: 10.1007/s00384-010-1091-6. Epub 2010 Dec 21.
Whether laparoscopic-assisted surgery (LS) can achieve the same oncologic outcomes compared with open surgery (OS) for rectal cancer remains controversial. The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare oncologic adequacy of resection and long-term oncologic outcomes of LS with OS in the treatment of rectal cancer.
Literature searches of electronic databases (Pubmed, Embase, Web of Science, and Cochrane Library) and manual searches were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence, and survival following LS and OS.
Six RCTs enrolling 1,033 participants were included in the meta-analysis. LS was associated with similar number of lymph nodes harvested and a similar distal tumor-free margin. LS was associated with a slightly high circumferential resection margin (CRM) positive rate with no significant difference (7.94% vs. 5.37%; risk ratio [RR], 1.13; P = 0.63). There was no significant difference between the two groups in local recurrence (RR, 0.55; P = 0.21). The 3-year overall survival advantage for LS over OS was not statistically significantly different (hazard ratio [HR], 0.76; P = 0.11). The 3-year disease-free survival was not significantly different between the two groups (HR, 1.16; P = 0.64).
The meta-analysis suggests that there are no differences between laparoscopic-assisted and open surgery in terms of number of lymph nodes harvested, involvement of CRM, local recurrence, 3-year overall survival, and disease-free survival for rectal cancer. However, more high-quality studies are needed for further analysis due to the small number of included studies.
腹腔镜辅助手术（LS）是否能达到与开腹手术（OS）相同的直肠癌肿瘤学结果仍存在争议。本荟萃分析的目的是比较直肠癌 LS 和 OS 的肿瘤学切除效果和长期肿瘤学结果。
对电子数据库（Pubmed、Embase、Web of Science 和 Cochrane Library）和手动搜索进行文献检索，以确定比较 LS 和 OS 治疗直肠癌时肿瘤学切除效果、复发和生存值的随机对照试验（RCT）。
纳入了 6 项 RCT，共 1033 名参与者。LS 组与 OS 组的淋巴结清扫数目相似，远端肿瘤无残留边界也相似。LS 组的环周切缘（CRM）阳性率略高，但无显著差异（7.94% vs. 5.37%；风险比 [RR]，1.13；P = 0.63）。两组局部复发率无显著差异（RR，0.55；P = 0.21）。LS 组与 OS 组的 3 年总生存率优势无统计学差异（HR，0.76；P = 0.11）。两组 3 年无病生存率无显著差异（HR，1.16；P = 0.64）。
荟萃分析表明，LS 和 OS 在淋巴结清扫数量、CRM 受累、局部复发、3 年总生存率和无病生存率方面无差异。然而，由于纳入研究数量较少，需要更多高质量的研究进一步分析。
