侧方淋巴结清扫在国内低位直肠癌治疗中应用的Meta分析

Meta-analysis of application of lateral lymph node dissection for low rectal cancer in China

目的:评价侧方淋巴结清扫在国内低位直肠癌治疗中应用价值.方法:运用M e t a分析的方法对我国2005-01/2015-09公开发表的有关侧方淋巴结清扫在低位直肠癌中应用的11篇文献资料进行综合分析.结果:侧方清扫组手术时间明显长于未清扫组,合并加权均数差(weighted mean d i ff e r e n c e,W M D)为47.79 m i n,且差异有统计学意义(P<0.00001).侧方清扫组手术失血量高于未清扫组,合并加权均数差为27.84 m L,且差异有统计学意义(P<0.0001).侧方淋巴结清扫组5年生存率高于未清扫组(59.8%vs 51.3%),差异具有统计学意义P<0.05(P=0.02).侧方淋巴结清扫组三年生存率明显高于未清扫组(81.6%vs63.5%),差异具有统计学意义(P<0.00001).侧方淋巴结清扫组的局部复发率明显低于未清扫组(8.4%vs 16.9%),差异具有统计学意义(P=0.0003).Ⅰ期及ⅡA期行侧方淋巴结清扫对于局部复发的影响差异无统计学意义(PⅠ期=0.96,PⅡA期=0.05).Ⅲ期低位直肠癌侧方淋巴结清扫组局部复发率明显低于未清扫组(14.5%vs 22.1%),P<0.05(P=0.01)差异具有统计学意义.结论:我国低位直肠癌患者行侧方淋巴结清扫能有效的延长患者的5年生存率及3年生存率,降低局部复发率(尤其是Ⅲ期低位直肠癌),改善患者预后,但会增加手术时间及术中出血量.

AIM：To assess the value of the application of lateral lymph node dissection（LLND） for low rectal cancer in China.METHODS：By meta-analysis we made a comprehensive analysis of the application of LLND for low rectal cancer based on 11 articles published in China between January 2005 and September 2015.RESULTS：Operative time was significantly longer in the LLND group than in the nonLLND（NLLND） group[weighted mean difference（WMD） = 47.79 min,P 0.00001].Intra-operative blood loss was significantly greater in the LLND group than in the NLLND group（WMD = 27.84,P 0.0001）.Five-year survival rate was significantly higher in the LLND group than in the NLLND group（59.38%vs 51.3%,P = 0.02）.Three-year survival rate was also significantly higher in the LLND group than in the NLLND group（81.6%vs 63.5%,P 0.00001）.Local recurrence rate for the NLLND group（16.9%）was significantly higher than that of the LLND group（8.4%）（P = 0.0003）.Local recurrence rate showed no statistical difference between the LLND group and the NLLND group for stageⅠ or ⅡA low rectal cancer,but was significantly lower in the LLND group than in the NLLND group for stage III rectal cancer（14.5%vs22.1%,P= 0.01）.CONCLUSION：Lateral lymph node dissection in Chinese patients with low rectal cancer can effectively prolong the 5-year survival rate and 3-year survival rate,decrease the local recurrence rate（especially in stage Ⅲ low rectal cancer） and improve the patient＇s prognosis,but it increases the operative time and the amount of bleeding.