术前长程放疗对直肠癌低位前切除术后吻合口瘘发生率影响的Meta分析

Effect of preoperative long course radiotherapy on anastomotic leakage after low anterior ;resection for rectal cancer：a Meta-analysis

目的：研究术前长程放疗对直肠癌低位前切除术后吻合口瘘发生率的影响。方法通过计算机检索PubMed、EMBASE、The Cochrane Library、中国期刊全文数据库（CNKI）中1990年1月至2013年12月间发表的有关术前长程放疗与直肠癌低位前切除术后吻合口瘘关系的文献。严格按照标准筛选后，评估文献质量并提取数据资料，最后用Review Manager 5．2软件进行系统评价。结果共检索文献881篇，最终10项非随机对照研究纳入分析。病例总数7829例，其中术前放疗组2581例，直接手术组5248例。 Meta分析结果显示，两组患者术后吻合口瘘发生率的差异无统计学意义（OR＝1．17，95％CI：0．98～1．39， P＝0．09）。结论术前长程放疗并未增加直肠癌低位前切除术后吻合口瘘的发生率。

Objective To assess the effect of preoperative long course radiotherapy （RT） on anastomotic leakage （AL） after low anterior resection （LAR） for rectal cancer. Methods Medline, EMBASE, China National Knowledge Infrastructure,the Cochrane Library databases and other databases were searched for relevant studies. Correlation between preoperative long course RT and AL after LAR for rectal cancer was examined. Review Manager 5.2 software was used to pool raw data and test the heterogeneity of existing studies and to calculate the incorporated odds ratio （OR） and 95% confidence interval （95%CI）. Finally, forest plots and funnel plots were created to allow for visual comparison of the results or the effect of publication bias. Results A total of 881 studies were identified and 10 studies （n=7829） were eligible for the meta-analysis, including 2581 cases of preoperative RT, and 5248 cases of surgery alone without RT. There was no significant difference in anastomotic leakage rate between the two groups（OR：1.17, 95%CI：0.98-1.39, P=0.09）. Conclusions Preoperative long course RT did not increase the risk of postoperative AL after LAR in patients with rectal cancer.