Ouyang Manzhao, Liao Tianyou, Lu Yan, Deng Leilei, Luo Zhentao, Wu Jinhao, Ju Yongle, Yao Xueqing
Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University, Shunde, Foshan, Guangdong Province 528300, China.
Department of General Surgery, Guangdong General Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong Province 510080, China.
Gastroenterol Res Pract. 2019 Mar 5;2019:7689082. doi: 10.1155/2019/7689082. eCollection 2019.
To compare the clinical efficacies between laparoscopic and conventional open surgery in lateral lymph node dissection (LLND) for advanced rectal cancer.
We comprehensively searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data and performed a cumulative meta-analysis. According to inclusion criteria and exclusion criteria, all eligible randomized controlled trials (RCTs) or retrospective or prospective comparative studies assessing the two techniques were included, and then a meta-analysis was performed by using RevMan 5.3 software to assess the difference in clinical and oncological outcomes between the two treatment approaches.
Eight studies involving a total of 892 patients were finally selected, with 394 cases in the laparoscopic surgery group and 498 cases in the traditional open surgery group. Compared with the traditional open group, the laparoscopic group had a longer operative time (WMD = 81.56, 95% CI (2.09, 142.03), = 0.008), but less intraoperative blood loss (WMD = -452.18, 95% CI (-652.23, -252.13), < 0.00001), shorter postoperative hospital stay (WMD = -5.30, 95% CI (-8.42, -2.18), = 0.0009), and higher R0 resection rate (OR = 2.17, 95% CI (1.14, 4.15), = 0.02). There was no significant difference in the incidence of surgical complications between the two groups (OR = 0.52, 95% CI (0.26, 1.07), = 0.08). Lateral lymph node harvest, lateral lymph node metastasis, local recurrence, 3-year overall survival, and 3-year disease-free survival did not differ significantly between the two approaches ( > 0.05).
Laparoscopic LLND has a similar efficacy in oncological outcomes and postoperative complications to the conventional open surgery, with the advantages of reduced intraoperative blood loss, shorter postoperative hospital stay, and higher R0 resection rate, and tumor radical cure is similar to traditional open surgery. Laparoscopic LLND is a safe and feasible surgical approach, and it may be used as a standard procedure in LLND for advanced rectal cancer.
比较腹腔镜手术与传统开放手术在进展期直肠癌侧方淋巴结清扫（LLND）中的临床疗效。
全面检索PubMed、Embase、Cochrane图书馆、中国知网和万方数据，并进行累积荟萃分析。根据纳入标准和排除标准，纳入所有评估这两种技术的合格随机对照试验（RCT）或回顾性或前瞻性比较研究，然后使用RevMan 5.3软件进行荟萃分析，以评估两种治疗方法在临床和肿瘤学结局方面的差异。
最终入选8项研究，共892例患者，腹腔镜手术组394例，传统开放手术组498例。与传统开放组相比，腹腔镜组手术时间更长（加权均数差（WMD）=81.56，95%置信区间（CI）（2.09，142.03），P = 0.008），但术中出血量更少（WMD = -452.18，95%CI（-652.23，-252.13），P < 0.00001），术后住院时间更短（WMD = -5.30，95%CI（-8.42，-2.18），P = 0.0009），R0切除率更高（比值比（OR）=2.17，95%CI（1.14，4.15），P = 0.02）。两组手术并发症发生率无显著差异（OR = 0.52，95%CI（0.26，1.07），P = 0.08）。两种方法在侧方淋巴结清扫、侧方淋巴结转移、局部复发、3年总生存率和3年无病生存率方面无显著差异（P > 0.05）。
腹腔镜LLND在肿瘤学结局和术后并发症方面与传统开放手术疗效相似，具有术中出血量减少、术后住院时间缩短和R0切除率更高的优点，并与传统开放手术的肿瘤根治效果相似。腹腔镜LLND是一种安全可行的手术方法，可作为进展期直肠癌LLND的标准术式。
