Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
Int J Surg. 2017 Mar;39:1-10. doi: 10.1016/j.ijsu.2016.12.123. Epub 2017 Jan 11.
To present a meta-analysis of high-quality published reports comparing laparoscopic rectal resection (LRR) and open rectal resection (ORR) for rectal cancer.
Studies that compared LRR and ORR and were published within the last 5 years were identified. All eligible randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) were evaluated based on the Jadad score, the Cochrane risk of bias assessment tool and modified Methodological Indices for Nonrandomized Studies (MINORS). The mean differences (MD) and odds ratios (OR) were used to compare the operative time, blood loss, mortality, complications, harvested lymph nodes, hospital stay, distal resection margin, and circumferential resection margin. The risk ratio (RR) method was used to examine recurrence and survival.
Fourteen studies were identified and included 7 RCTs and 7 NRCTs and 4353 patients (2251 LRR, 2102 ORR). Although the operation time of the LRR group was obviously longer than that of the conventional surgery group (MD = 25.64, 95%CI = [5.17,46.10], P = 0.01), LRR was associated with fewer overall complications (OR = 0.67, 95%CI = [0.52,0.87], P = 0.002), less blood loss (MD = -66.49, 95%CI = [-88.31, -44.66], P < 0.00001), shorter postoperative hospital stays (OR = -1.26,95%CI = [-2.45, -0.07],P = 0.004) and shorter bowel function recovery times (MD = -0.93, 95%CI = [-1.27,-0.58], P < 0.00001). Moreover, the difference in the DRM was statistically clear (MD = 0.14, 95%CI = [0.02,0.27], P = 0.03). However, no significant differences between the LRR and ORR groups were observed in terms of the number of lymph nodes harvested, mortality, positive CRM, local and distal recurrence, or overall and disease-free survival.
This study indicates that there are no significant differences between LRR and ORR in terms of survival and pathological outcomes with the exception of the DRM. Moreover, this study suggests that LRR can be performed safely and elicits faster recovery times compared with conventional surgery.
对比较腹腔镜直肠切除术（LRR）和开腹直肠切除术（ORR）治疗直肠癌的高质量已发表报告进行荟萃分析。
检索了过去 5 年内比较 LRR 和 ORR 的研究。根据 Jadad 评分、Cochrane 偏倚风险评估工具和改良非随机研究方法学指数（MINORS）对所有合格的随机对照试验（RCT）和非随机对照试验（NRCT）进行评估。使用均数差值（MD）和比值比（OR）比较手术时间、出血量、死亡率、并发症、采集的淋巴结数量、住院时间、远端切缘和环周切缘。使用风险比（RR）方法检查复发和生存情况。
共纳入 14 项研究，包括 7 项 RCT 和 7 项 NRCT，共 4353 例患者（LRR 组 2251 例，ORR 组 2102 例）。尽管 LRR 组的手术时间明显长于传统手术组（MD=25.64，95%CI=[5.17,46.10]，P=0.01），但 LRR 与总并发症发生率较低相关（OR=0.67，95%CI=[0.52,0.87]，P=0.002），出血量较少（MD=-66.49，95%CI=[-88.31, -44.66]，P<0.00001），术后住院时间较短（OR=-1.26，95%CI=[-2.45, -0.07]，P=0.004），肠道功能恢复时间较短（MD=-0.93，95%CI=[-1.27,-0.58]，P<0.00001）。此外，在 DRM 方面的差异具有统计学意义（MD=0.14，95%CI=[0.02,0.27]，P=0.03）。然而，LRR 和 ORR 组在采集的淋巴结数量、死亡率、阳性 CRM、局部和远处复发、总生存和无病生存方面无显著差异。
本研究表明，LRR 和 ORR 在生存和病理结果方面除 DRM 外无显著差异。此外，本研究表明，LRR 与传统手术相比可安全进行，且恢复时间更快。
