直肠癌根治术加侧方淋巴结清扫术与单纯根治性手术比较的Meta分析

Lateral lymph node dissection with radical surgery versus single radical surgery for rectal cancer:a Meta analysis

目的：评价直肠癌侧方淋巴结清扫术（lateral lymph node dissection, LLND）在直肠癌根治术中的价值.方法：检索国内外公开发表的有关直肠癌LLND的中文和英文文献,最终符合入选标准的文献共15篇,包含4 858例患者,其中LLND组2 401例,NLLND组（非LLND）2 457例.评价指标包括5年生存率、复发率、围手术期情况以及术后泌尿系统功能和性功能情况等.结果： NLLND组的手术时间较LLND组明显缩短[加权均数差（weighted mean difference, WMD）为109 min,95% 可信区间（confidence interval,CI）为90～129,P＜0.000 01];LLND组的术中失血量大于NLLND组,但差异无统计学意义（WMD为429 mL,95%CI为325～854,P=0.05）;LLND组的围手术期并发症发生率明显高于NLLND组[比值比（odds ratio,OR）为1.57,95%CI为1.06～2.33,P=0.02].LLND组与NLLND组的手术后5年生存率差异无统计学意义（OR为0.94,95%CI为0.78～1.12,P=0.48）;LLND组与NLLND组总的手术后复发率差异无统计学意义（OR为0.92,95%CI为0.70～1.22,P=0.57）.此外,NLLND组发生泌尿系统功能障碍的可能性低于LLND组（OR为5.12,95%CI为2.15～12.19,P=0.000 2）;个别研究报道NLLND组男性患者的性功能障碍发生率低于LLND组（P＜0.05）.结论：Meta分析结果显示,LLND组在降低术后复发率和延长生存期方面未显示出明显优势,但LLND组的围手术期并发症发生率有所增加、手术时间延长、手术出血量增加,术后性功能和泌尿系统功能障碍的发生率也均有所增加.

Objective：To assess the value of lateral lymph node dissection （LLND） in the radical surgery of rectal cancer. Methods：The published Chinese and English literature about LLND was retrieved. Totally 15 literature fitted the selection criteria, which included 4 858 patients. Among them 2 401 patients were in LLND group and 2 457 patients in non-LLND （NLLND） group. The evaluation parameters included 5-year survival rate, recurrence rate, peri-operative outcomes, postoperative urinary and sexual fimctions. Results：The operating time was significantly shorter in the NLLND group than that in the LLND group [ weighted mean difference （WMD） = 109 min, 95% confidence interval（CI） ： 90-129; P 〈0. 000 011- Intra-operative blood loss was greater in the LLND group than that in the NLLND group but the difference was not significant （ WMD = 429 mL, 95% CI： 325-854 ;P = 0.05 ）. The frequency of peri-operative morbidity （OR： 1.57 95% CI： 1.06-2.33 ;P = 0.02） was significantly higher in the LLND groups compared with the NLLND group. There were no significant differences in 5-year survival rate （ OR： 0. 94, 95% CI： 0. 78-1. 12;P =0.48）, and recurrence rate （OR： 0. 92, 95% CI： 0. 70-1.22;P = 0.57） between the two groups. Data from individual studies（ three studies） showed that the frequency of male urinary dysfunction （OR： 5.12, 95 % CI： 2.15-12.19; P = 0. 000 2 ） and sexual dysfunction （P 〈 0.05 ） were greatly lower in the NLLND group than those in the LLND group, Conclusion：Meta analysis showed that LLND did not have specific advantage in decreasing postoperative recurrence and prolonging survival time, LLND was associated with prolonged operation time, in- creased blood loss, and elevated incidence of peri-operative complications and urinary, and sexual dysfunction.