Wang Ling, Zhang Zhen, Gong Lian, Zhan Yuting, Li Mengqing, Li Shuman, Xiao Yongbo
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Graduate School of Tianjin Medical University, Tianjin, China.
J Laparoendosc Adv Surg Tech A. 2019 May;29(5):663-670. doi: 10.1089/lap.2018.0069. Epub 2019 Jan 16.
Our aim was to perform a Bayesian network meta-analysis of short-term and long-term outcomes of open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) after neoadjuvant chemoradiotherapy (nCRT) for rectal cancer. We searched randomized controlled trials (RCTs) and non-RCTs published up to October 2018 from PubMed, Embase, Cochrane Library, and Web of Science. We selected studies referencing the comparison between at least two of OS, LS, and RS. Short-term and long-term outcomes of different surgery procedures were evaluated. Mean differences or odds ratios and their 95% credible interval were pooled with Bayesian modeling. In the network meta-analysis, 15 studies were identified through database searching and other sources that included three RCTs and nine non-RCTs enrolling 2360 patients. As for long-term outcomes, we did not find any significant difference among these surgery procedures after nCRT for rectal cancer in this network meta-analysis. As for short-term outcomes, no significant outcomes were obtained except for operative time, blood loss, length of incision, and time to pass first flatus. Our meta-analysis illustrated that RS had the longest operative time. However, LS had a significantly shorter operative time than RS, shorter incision than OS, shorter time to pass first flatus than OS, and less blood loss than OS. RS was regarded as the inferior surgery procedure after nCRT for rectal cancer. Meanwhile, LS might possibly be the most safe and feasible surgery procedure after nCRT for rectal cancer.
我们的目的是对直肠癌新辅助放化疗（nCRT）后开放手术（OS）、腹腔镜手术（LS）和机器人手术（RS）的短期和长期结局进行贝叶斯网络荟萃分析。我们检索了截至2018年10月在PubMed、Embase、Cochrane图书馆和科学网发表的随机对照试验（RCT）和非RCT。我们选择了至少涉及OS、LS和RS中两者比较的研究。评估了不同手术方式的短期和长期结局。通过贝叶斯建模汇总平均差异或比值比及其95%可信区间。在网络荟萃分析中，通过数据库检索和其他来源确定了15项研究，其中包括3项RCT和9项非RCT，共纳入2360例患者。对于长期结局而言，在该网络荟萃分析中，我们未发现直肠癌nCRT后这些手术方式之间存在任何显著差异。对于短期结局，除手术时间、失血量、切口长度和首次排气时间外，未获得显著结果。我们的荟萃分析表明，RS的手术时间最长。然而，LS的手术时间明显短于RS，切口比OS短，首次排气时间比OS短，失血量比OS少。RS被认为是直肠癌nCRT后的较差手术方式。同时，LS可能是直肠癌nCRT后最安全可行的手术方式。
