Zhang Feng-Wa, Zhou Zhao-Yu, Wang Hai-Lin, Zhang Jv-Xia, Di Bao-Shan, Huang Wen-Hui, Yang Ke-Hu
The First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, China E-mail :
Asian Pac J Cancer Prev. 2014;15(22):9985-96. doi: 10.7314/apjcp.2014.15.22.9985.
Laparoscopic and open rectum surgery for rectal cancer remains controversial. This systematic review compared the short-term and long-term efficiency and complications associated with laparoscopic and open resection for rectal cancer.
We searched PubMed, Embase, Cochrane Library, ISI Web of Knowledge and the China Biology Medicine Database to identify potential randomized controlled trials from their inception to March 31, 2014 without language restriction. Additional articles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessed the full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodological quality of included trials. The meta-analysis was performed using RevMan 5.2.
A total of 16 randomized controlled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) were reviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier return of bowel movement and reduced length of hospital stay as compared to open surgery, although with increased operative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowel obstruction. Importantly, there were no significant differences in other postoperative complications, oncological clearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures.
On the basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperative recovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcome is comparable after laparoscopic and open resection for rectal cancer.
腹腔镜直肠癌手术与开放直肠癌手术仍存在争议。本系统评价比较了腹腔镜直肠癌切除术与开放直肠癌切除术的短期和长期疗效及并发症。
检索PubMed、Embase、Cochrane图书馆、ISI Web of Knowledge和中国生物医学数据库，以识别从建库至2014年3月31日的潜在随机对照试验，无语言限制。通过检索已检索文章的参考文献来识别其他文章。两名评价者根据预先指定的纳入和排除标准以及纳入试验的方法学质量，独立评估全文文章。使用RevMan 5.2进行荟萃分析。
共纳入16项随机对照试验，涉及3045名参与者（腹腔镜组1804例；开放组1241例）。与开放手术相比，腹腔镜手术术中失血显著减少、肠道功能恢复更早、住院时间缩短，尽管手术时间延长。在减少粘连相关肠梗阻的晚期并发症方面也显示出明显优势。重要的是，两种手术在其他术后并发症、肿瘤清除率、3年、5年或10年复发率及生存率方面无显著差异。
基于本荟萃分析，我们得出结论，腹腔镜手术具有术后恢复早、失血少和粘连相关肠梗阻发生率低的优势。此外，腹腔镜直肠癌切除术和开放直肠癌切除术的肿瘤学结局相当。
