低位直肠癌侧方淋巴结清扫与TME预后比较的Meta分析

The comparison of prognosis of Lateral lymph node dissection with radical surgery versus TME(Total mesorectal excision) radical surgery for the lower rectal cancer: a Meta analysis

目的探讨直肠癌全系膜切除术（TME）侧方淋巴结清扫（LLND）在下段直肠癌治疗中的价值。方法利用meta分析的方法综合评价国内外公开发表的所有关于低位直肠癌侧方淋巴结清扫的文献。最终符合选入标准的文献15篇,包含4509例患者,其中LLND组2256例,非LLND组2253例。评价指标：术后泌尿功能和性功能情况的比较、术后复发率、5年生存率。结果 LLND组引起泌尿和性功能障碍的可能性较高（OR为4.43,95%置信区间为2.49~7.89,P〈0.00001）;术后复发率LLND组明显低于非LLND组（OR为0.66,95%置信区间为0.54~0.81,P〈0.0001）。术后5年生存率LLND组与非LLND组无明显统计学差异[比值比（OR）为0.91,95%置信区间（CI）为0.76~1.10,P=0.34）]。结论 META分析结果显示,LLND组在降低局部复发率方面明显优于非LLND组,但LLND组在提高生存率方面未能表现出优势,且LLND组泌尿和性功能障碍的发生率较高。

【Objective】 To explore the therapy value of lateral lymph node dissection（lateral lymph node dissection,LLND） in the lower rectal cancer.【Methods】 Synthetically assessed the literatures all about lateral lymph node dissection of lower rectal cancer by meta analysis.Finally,15 literatures including 4509 patients were according with standard.Among them,2256 patients in LLND group and 2253 patients in non-LLND（NLLND） group.The evaluation parameters included postoperative urinary and sexual functions,5-year survival rate and recurrence rate.【Results】 The frequency of male urinary dysfunction and sexual dysfunction were greatly lower in the NLLND group than those in the LLND group（OR： 4.43,95%CI： 2.49～7.89,P 0.00001）;Postoperative recurrence rate LLND group was significantly lower than the LLND group（OR： 0.66,95%CI： 0.54～0.81,P 〈0.0001）.There were no significant differences in 5 years survival rate（OR： 0.91,95%CI： 0.76～1.10,P =0.34）.【Conclusion】 Meta analysis showed that LLND have specific advantage in decreasing postoperative recurrence while it can not prolong survival time;while,LLND was elevated incidence of urinary and sexual dysfunction.