经肛门全直肠系膜切除术在中低位直肠癌患者中的应用：一项系统评价和荟萃分析。
The application of transanal total mesorectal excision for patients with middle and low rectal cancer: A systematic review and meta-analysis.
作者信息
Hu Dongping, Jin Penghui, Hu Lidong, Liu Wenhan, Zhang Weisheng, Guo Tiankang, Yang Xiongfei
机构信息
Gansu Provincial Hospital Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
出版信息
Medicine (Baltimore). 2018 Jul;97(28):e11410. doi: 10.1097/MD.0000000000011410.
BACKGROUND
Recently, in order to overcome the shortcomings of laparoscopic surgery in the treatment of low rectal cancer, a new kind of surgical procedure, transanal total mesorectal excision (TaTME), has rapidly become a research hotspot in the field of rectal cancer surgery study. Our study aimed to evaluate the efficacy and safety of transanal total mesorectal excision (TaTME) for the patients with rectal cancer.
METHODS
Relevant studies were searched from the databases of the Cochrane Library, PubMed, Embase, Web of science. All relevant studies were collected to evaluate the efficacy and safety of TaTME for patients with rectal cancer. The quality of the included studies was assessed by the Newcastle-Ottawa Quality Assessment Scale (NOS) and Cochrane Library Handbook 5.1.0. Data analysis was conducted using the Review Manager 5.3 software.
RESULTS
Thirteen studies including 859 patients were included in our analysis. In terms of efficacy, compared with laparoscopic total mesorectal excision (LaTME), meta-analysis showed that the rate of complete tumor resection increased and the risk of positive circumferential margins decreased in the TaTME group. For complete tumor resection and positive circumferential margins in the TaTME group, the odds ratios (ORs) and 95% confidence intervals (CIs) were 1.93 and 1.09 to 3.42 (P = .02) and 0.43 and 0.22 to 0.82 (P = .01), respectively. Concerning safety, results showed that the rates of postoperative complications were similar in the 2 groups, and differences in the risk of ileus and anastomotic leakage were not statistically significant (OR = 0.75, 95%CI = 0.51-1.09, P = .13; OR = 0.91, 95%CI = 0.46-1.78, P = .78; OR = 0.79, 95%CI = 0.45-1.38, P = .40).
CONCLUSIONS
The results of this meta-analysis show that TaTME is associated with a reduced positive circumferential resection margin (CRM) rate, and could achieve complete tumor resection and improved the long-term survival in patients with mid- and low-rectal cancer.
背景
近年来，为克服腹腔镜手术治疗低位直肠癌的不足，一种新型手术方式——经肛门全直肠系膜切除术（TaTME）迅速成为直肠癌手术研究领域的热点。本研究旨在评估经肛门全直肠系膜切除术（TaTME）治疗直肠癌患者的疗效及安全性。
方法
从Cochrane图书馆、PubMed、Embase、Web of science数据库检索相关研究。收集所有相关研究以评估TaTME治疗直肠癌患者的疗效及安全性。采用纽卡斯尔-渥太华质量评估量表（NOS）和Cochrane图书馆手册5.1.0评估纳入研究的质量。使用Review Manager 5.3软件进行数据分析。
结果
本分析纳入13项研究，共859例患者。在疗效方面，与腹腔镜全直肠系膜切除术（LaTME）相比，Meta分析显示TaTME组肿瘤完整切除率提高，环周切缘阳性风险降低。对于TaTME组的肿瘤完整切除和环周切缘阳性情况，优势比（OR）及95%置信区间（CI）分别为1.93（1.09至3.42，P = 0.02）和0.43（0.22至0.82，P = 0.01）。在安全性方面，结果显示两组术后并发症发生率相似，肠梗阻和吻合口漏风险差异无统计学意义（OR = 0.75，95%CI = 0.51 - 1.09，P = 0.13；OR = 0.91，95%CI = 0.46 - 1.78，P = 0.78；OR = 0.79，95%CI = 0.45 - 1.38，P = 0.40）。
结论
本Meta分析结果表明，TaTME与降低环周切缘阳性率相关，可实现肿瘤完整切除并改善中低位直肠癌患者的长期生存。
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