Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands.
Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands.
Br J Surg. 2020 Apr;107(5):489-498. doi: 10.1002/bjs.11566. Epub 2020 Mar 10.
Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. A novel approach to performing TME is by single-port transanal minimally invasive surgery. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME.
A comprehensive search in PubMed, the Cochrane Library, Embase and the trial registers was conducted in May 2019. PRISMA guidelines were used. Data for meta-analysis were pooled using a random-effects model.
A total of 11 660 studies were identified, from which 14 studies and six conference abstracts involving 846 patients (599 transanal TME, 247 laparoscopic TME) were included. A substantial number of patients experienced functional problems consistent with low anterior resection syndrome (LARS). Meta-analysis found no significant difference in major LARS between the two approaches (risk ratio 1·13, 95 per cent c.i. 0·94 to 1·35; P = 0·18). However, major heterogeneity was present in the studies together with poor reporting of functional baseline assessment.
No differences in function were observed between transanal and laparoscopic TME.
全直肠系膜切除术（TME）在直肠癌治疗中能获得优异的肿瘤学结果，但患者可能会出现功能问题。一种新的 TME 手术方法是经肛门单孔微创外科手术。本系统评价评估了经肛门和腹腔镜 TME 后的功能结果和生活质量。
2019 年 5 月，我们在 PubMed、Cochrane 图书馆、Embase 和试验登记处进行了全面检索。使用 PRISMA 指南。使用随机效应模型汇总荟萃分析数据。
共确定了 11660 项研究，其中纳入了 14 项研究和 6 份会议摘要，涉及 846 名患者（599 名经肛门 TME，247 名腹腔镜 TME）。相当多的患者出现与低位前切除术综合征（LARS）一致的功能问题。荟萃分析发现，两种方法之间的主要 LARS 无显著差异（风险比 1.13，95%置信区间 0.94 至 1.35；P = 0.18）。然而，研究中存在很大的异质性，并且对功能基线评估的报告不佳。
经肛门和腹腔镜 TME 之间的功能无差异。
