腹腔镜与传统开腹直肠癌术后复发率和死亡率比较的随机对照试验荟萃分析

Laparoscopic Versus Open Rectectomy for Rectal Cancer: A Meta-analysis of Randomized Controlled Trials on Recurrence and Mortality

目的评价比较腹腔镜与开腹直肠癌手术的术后复发率和死亡率的长期肿瘤学效果。方法系统检索Medline、Embase、Cochrane数据库中1991年1月至2012年10月间发表的有关腹腔镜与开腹直肠癌手术后复发和死亡率的随机对照研究(randomized control trials,RCTs)。由两名评价员独立筛选并提取数据资料,对符合纳入标准的研究使用RevMan5软件进行统计分析。结果共纳入12个临床随机对照研究,病例总数2 259例,其中腹腔镜直肠癌切除组(laparoscopic resection for rectal cancer,LRR)1 158例,开腹直肠癌切除组(open resection for rectal cancer,ORR)1 101例。两组术后总体复发率(OR:0.92,95%CI:0.66~1.28,P=0.61)、局部复发率(OR:0.79,95%CI:0.49~1.28,P=0.34)、远处转移率(OR:0.87,95%CI:0.59~1.27,P=0.47)及穿刺口或切口种植转移率(OR:1.34,95%CI:0.07~24.10,P=0.84)、总体死亡率(OR:0.80,95%CI:0.60~1.07,P=0.13)和癌症相关死亡率(OR:0.71,95%CI:0.45~1.12,P=0.14)比较差异无统计学意义。结论腹腔镜直肠切除术对比传统开腹手术治疗直肠癌其术后长期肿瘤学疗效相当,不会导致术后各类复发率和死亡率明显升高,但其长期生存效果需要更多大样本、高质量的前瞻性多中心的临床随机对照试验来证实。

Objective To compare the recurrence and mortality between laparoscopic and conventional open rectectomy for rectal cancer with meta-analysis. Methods Eligible articles were identified using MEDLINE, EMBASE and Cochrane database between January 1991 and October 2012 at the terms of laparoscopy, surgery, minimal invasive, rectectomy, rectal neoplasms and randomized controlled trial. Prospective randomized control trials(RCTs)were eligible if they included patients with rectal cancer treated by laparoscopic surgery and open surgery followed-up by recurrence and mortality. Data were extracted from these trials by two independent reviewers. RevMan5 was used to statistically analyze the suitable researches. Results There are 12 RCTs with recurrence and mortality information of 2259 patients were involved, 1158 cases of laparoscopic resection for rectal cancer, LRR group and 1101 cases of open resection for rectal cancer, ORR group. In the combined results, no significant difference was found in overall recurrence rate(OR: 0.92,95%CI:0.66 to 1.28,P=0.61), local recurrence rate(OR: 0.79,95%CI:0.49 to 1.28,P=0.34), distant metastasis(OR: 0.87,95%CI:0.59 to 1.27,P=0.47), port-site or wound-site recurrence rate(OR: 1.34,95%CI:0.07 to 24.10,P=0.84), overall mortality rate(OR: 0.80,95%CI: 0.60 to 1.07,P=0.13) and cancer-related mortality rate(OR: 0.71,95%CI:0.45 to 1.12,P=0.14) between the laparoscopic surgery and open surgery group.Conclusion The recurrence and mortality rates for patients with rectal cancer treated by laparoscopic surgery are not significantly different from those by open surgery. Longer follow-up RCTs will further define the outcomes by comparing the two techniques in the treatment of rectal cancer.