直肠癌腹腔镜与开腹手术肿瘤清除及远期疗效的随机对照试验荟萃分析

Meta-analysis of randomized controlled trials comparing laparoscopic with open surgery for rectal cancer on oncologic clearance and long-term oncologic outcomes

目的探讨腹腔镜手术治疗直肠癌的肿瘤清除情况及长期疗效。方法利用电子数据库和手工检索等方法检索Pubmed,Embase。WebofScience及CochraneLibrary截止至2010年6月30日的所有随机对照试验（RCT）文献。评价指标为淋巴结获取数、肿瘤长期疗效（局部复发、切口复发、总体复发、总体生存率及无病生存率）。采用固定效应模型和随机效应模型对直肠癌腹腔镜手术与开腹手术的肿瘤清除情况及长期疗效指标进行荟萃分析。结果符合入选标准的RCT文献有6项共计1033例患者．腹腔镜手术组与开腹手术组分别为577例和456例。两组的淋巴结获取数差异无统计学意义（WMD=-0．38，95％CI：-1．35～0．58，P=0．43）。腹腔镜组环周切缘阳性率（7．94％）高于开腹手术组（5．37％），但差异无统计学意义[风险比（RR）=1．13，95％CI：0．69-1．85，P=0．63]。局部复发率比较。差异无统计学意义（RR=O．55，95％CI：0．22-1．40，P=0．21）。两组3年总体生存率比较[危险比（HR）=O．76，95％CI：0．54-1．07，P=0．11]。差异无统计学意义；两组3年无病生存率比较（HR=1．16，95％CI：0．61-2．20，P=0．64），差异亦无统计学意义。结论直肠癌腹腔镜手术在肿瘤清除及长期疗效方面至少与开腹手术相当。

Objective To compare oncologic adequacy of resection and long-term oncologic outcomes between laparoscopic-assisted surgery （LS） and open surgery （OS） in the treatment of rectal cancer. Methods Literature searches of electronic databases （PubMed, Embase, Web of Science,and Cochrane Library） and manual searches up to June 30,2010 were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence and survival following LS and OS. Fixed and random effects models were used. Results Six RCTs enrolling 1033 participants （LS group：577 cases, OS group：456 cases）were included in the meta-analysis. Number of lymph node harvested was similar （WMD=-0.38,95% CI：-1.35-0.58,P=0.43）. LS had a slightly higher circumference resection margin （CRM） positive rate with no statistical significance [7.94% vs. 5.37%; risk ratio （RR）=1.13; 95% CI：0.69-1.85,P=0.63]. There was no significant difference between the two groups in local recurrence （RR=0.55; 95% CI：0.22-1.40, P=0.21）. The 3-year overall survival [Hazard ratio（HR）= 0.76; 95% CI：0.54-1.07,P=0.111 and 3-year disease-free survival （HR=I.16; 95% CI：0.61-2.20, P=0.64） were not significantly different between the two groups. Conclusion Compared with open surgery, laparoscopic surgery of rectal carcinoma offers similar oncological clearance and long-term oncological outcomes.