肠系膜下动脉低位结扎伴D3淋巴结清扫术治疗乙状结肠与直肠癌疗效的Meta分析

Efficacy of inferior mesenteric artery low ligation with D3 lymph node dissection in sigmoid and rectal cancer surgery:a systematic review and meta-analysis

目的:通过评估生存优势与安全性,比较肠系膜下动脉(IMA)低位结扎伴D3淋巴结清扫术(LLD3)与高位结扎治疗结直肠癌的临床疗效。方法:系统检索PubMed、Embase、Web of Science、The Cochrane Library及中国生物医学文献数据库(CBM)、CNKI、维普、万方中自建库至2019年5月收录的比较LLD3与高位结扎术治疗乙状结肠癌或直肠癌的相关文献。采用Stata 14进行统计分析。结果:共纳入15篇文献,两组IMA根部淋巴结清扫数量及5年生存率、5年无瘤生存率、局部复发率差异均无统计学意义。LLD3组吻合口漏、术后排尿功能障碍发生率均低于高位结扎组(OR=1.69,95%CI=1.29~2.23;OR=2.45,95%CI=1.39~4.33),但LLD3组需要更长的手术时间(WMD=-6.82,95%CI=-12.58^-1.06)。结论:LLD3可获得与高位结扎相近的淋巴结清扫数量、等效的长期生存收益,同时可降低吻合口漏、排尿功能障碍的发生率;具备传统观点中两种标准结扎方式的优势,更适合乙状结肠与直肠癌手术。

Objective:To compare low inferior mesenteric artery(IMA) ligation with D3 dissection(LLD3) with high IMA ligation(HL) for the treatment of colorectal cancer by evaluating survival benefit and safety.Methods:PubMed,Embase,the Cochrane Library,Web of Science,CBM,CNKI,VIP and WanFang were systematically searched for relevant articles which compared HL and LLD3 for sigmoid or rectal cancer published from the inception to May 2019.All statistical analyses were performed using Stata 14.Results:Fifteen studies were included in this analysis.There were no differences between groups for the number of harvested lymph nodes,either total or around root of IMA.Local recurrence rate,the 5-year overall survival rates(OS) and the 5-year disease-free survival rates(DFS) were also not detected significant differences between two groups.The incidences of anastomotic leakage and urination dysfunction were significantly lower in patients treated with LLD3 than in those treated with HL(OR=1.69,95% CI=1.29 to 2.23;OR=2.45,95% CI=1.39 to 4.33,respectively).However,longer operation time was required in LLD3 group(WMD=-6.82,95% CI=-12.58 to-1.06).Conclusions:LLD3 could obtain similar lymph node harvested,equivalent survival benefit to HL,and associates with lower incidence of leakage and urination dysfunction.So based on the current available evidence,LLD3 has been proven to have the advantages of the two standard ligation methods,and is more suitable for sigmoid and rectal cancer surgery.