Meta analysis of laparoscopic versus open total mesorectal excision with sphincter-preservation for treating low rectal cancer / 重庆医学

ABSTRACT

Objective To evaluate the safety and efficacy of laparoscopitotal mesorectal excision (TME) with sphincter-preservation in the treatmenof low rectal cancerby using metanalysi.MethodThe electronidatabase(PubMed ,Medline ,Ov-id ,Cochrane Library ,Controlled TrialRegistry ,SinoMedCBM ,Wanfang Dat,CNKI ,VIP ,eal) were retrieved .The related litera-tureon the randomized controlled trail(RCTs) and the non-randomized controlled trails(non-RCTs) comparing laparoscopiver-sulaparotomy TME with sphincter-preservation fotreating low rectal cancepublished from January 2001 to Octobe2012 were collected .The RevMan5 .2 software waused to conducthe metanalysi.ResultTwelve studieincluding 1 508 patientwere included ,in which the laparoscopigroup had 781 caseand the laparotomy group had 727 case.The metanalysiresultshowed thacompared with the laparotomy group ,the laparoscopiTME(LTME) group with sphincter-preservation had significantly lesestimated blood loss[mean difference(MD)= -67 .13 ,95% confidence interval(CI) (-78 .74 ,-55 .51) ,P＜0 .01] ,longedistal resection margins[MD=0 .15 ,95% CI(0 .01 ,0 .29) ,P= 0 .04] ,earlieintestinal functional recovery [MD= -1 .16 ,95% CI (-1 .32 ,-1 .01) ,P＜0 .01] ,shortehospital stay [MD= -3 .99 ,95% CI (-5 .36 ,-2 .63) ,P＜0 .01) ,lestotal morbidity [oddratio(OR)=0 .40 ,95% CI (0 .25 ,0 .63) ,P＜0 .01] ,anastomotileakage[OR=0 .60 ,95% CI (0 .37 ,0 .96) ,P=0 .03] ,urinary re-tention[OR=0 .40 ,95% CI(0 .18 ,0 .87) ,P=0 .02] and incision infection[OR=0 .26 ,95% CI(0 .11 ,0 .61) ,P=0 .002] .The statis-tically significandifferencewere nofound between the two groupin the numbeof lymph node dissection,length of resected specimen ,postoperative obstruction and the 2-yeaoverall survival rate(P＞0 .05) .Conclusion LTME with sphincter-preservation fotreating low rectal cancehathe advantageof lessurgical traum,rapid postoperative recovery and few complication.Never-theles,iineeded to conducfurtheresearch fovalidating whetheLTME with sphincter-preservation having the superiority in the aspectof postoperative anal function recovery and long-term outcome .