Systematicreviewofoncologicaloutcomesfollowinglaparoscopicvs open totalmesorectalexcision

• 作者: Ahmad A Baig MK Miles WFA Sajid MS
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: 总计 mesorectal 切除 前面的切除术 Abdominoperineal 切除术 直肠的癌症 Oncological 结果
• 年，卷（期）: 2014,（5）
• 页码范围: 209-219
• 页数: 11页
• 分类号: R

摘要

AIM: To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision(LTME) vs open total mesorectal excision(OTME) in the management of rectal cancer.METHODS: Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan? statistical software. The combined outcome of the binary variables was expressed as odds ratio(OR) and the combined outcome of the continuous variables waspresented in the form of standardized mean difference(SMD). RESULTS: Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection(OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection(OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay(SMD,-1.59; 95%CI:-0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.CONCLUSION: LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.