新辅助放化疗后行腹腔镜手术与开腹手术治疗进展期直肠癌的meta分析

Meta-analysis of laparoscopic versus open surgery for advanced rectal cancer after neoadjuvant chemoradiotherapy

目的:应用meta分析评价新辅助放化疗后行腹腔镜手术与开腹手术治疗进展期直肠癌的可行性及疗效。方法:利用计算机检索Pub Med、Embase、Cochrane Library等数据库,检索新辅助放化疗后行腹腔镜手术对比开腹手术治疗进展期直肠癌的英文文章,采用Rev Man 5.3软件进行meta分析。结果:共纳入2篇随机对照试验、7篇非随机对照试验,共1 338例患者,其中腹腔镜组691例,开腹组647例,meta分析结果显示,新辅助放化疗后,两组患者环周切缘阳性(OR=1.24,95%CI:0.74~2.08,P=0.42)、淋巴结摘除数量(WMD=-0.35,95%CI:-1.48~0.78,P=0.54)差异均无统计学意义;腹腔镜组手术时间长于开腹组(WMD=26.26,95%CI:4.59~47.92,P=0.02),但术中出血量(WMD=-46.48,95%CI:-72.85^-20.11,P=0.0006)、术后住院时间(WMD=-1.80,95%CI:-2.85^-0.74,P=0.0009)、术后并发症(OR=0.77,95%CI:0.60~0.99,P=0.04)均少于开腹组;二次手术(OR=1.30,95%CI:0.61~2.77,P=0.49)两组差异无统计学意义。结论:短期疗效、病理学结果显示,新辅助放化疗后行腹腔镜手术与传统开腹手术治疗进展期直肠癌是安全、有效的。

Objective： To conduct a meta-analysis evaluating the feasibility and efficacy of laparoscopic surgery（ LS） versus open surgery（ OS） for advanced rectal cancer after neoadjuvant chemoradiotherapy（ NCRT）. Methods： The Pub Med,Embase and the Cochrane Library were electronically searched. Randomized controlled trials（ RCTs） and non-randomized controlled trials（ n-RCTs）published in English comparing the outcomes of LS versus OS for advanced rectal cancer with NCRT were identified. Rev Man 5. 3 software was used for this meta-analysis. Results： Two RCTs and seven n-RCTs totaling 1 338 patients（ LS = 691,OS = 647） were analyzed. Meta-analysis showed that there were no significant differences in pathology results： positive circumferential resection margin[odds ratio（ OR） = 1. 24,95% CI： 0. 74 ~ 2. 08,P = 0. 42] and the number of lymph nodes harvested [weighted mean difference（ WMD） =-0. 35,95% CI：-1. 48 ~ 0. 78,P = 0. 54]between LS and OS for advanced rectal cancer after NCRT. LS was associated with significantly delayed operative time（ WMD = 26. 26,95% CI： 4. 59 ~ 47. 92,P = 0. 02）,less blood loss（ WMD =-46. 48,95% CI：-72. 85 ^-20. 11,P = 0. 0006）,shorter length of hospital stay（ WMD：-1. 80,95% CI：-2. 85 ^-0. 74,P = 0. 0009） and fewer postoperative complications（ OR = 0. 77,95% CI： 0. 60 ~ 0. 99,P = 0. 04）. There was no significant difference in the reoperation（ OR =1. 30,95% CI： 0. 61 ~ 2. 77,P = 0. 49） between LS and OS for advanced rectal cancer after NCRT. Conclusions： LS versus OS for advanced rectal cancer after NCRT is proved to be safe and effective in the short-term treatment and pathology results.