Laparoscopic Total Mesorectal Excision versus Open Total Mesorectal Excision for Rectal Cancer: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUZhou ,  DONGWei-guo , ZHANGJi-xiang , LIUYu-lan , WUDan-dan

Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding?author：

DONGWei-guo, Email: dwg@whu.edu.cn

Keywords：

Laparoscopic; Open surgery; Rectal cancer; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140181

Video：

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Objective To systematically review the effectiveness and safety of laparoscopic total mesorectal excision(LTME) vs. open total mesorectal excision (OTME) in treating rectal cancer. Methods Randomized controlled trials (RCTs) about LTME vs. OTME for rectal cancer were searched in PubMed, The Cochrane Library (Issue 4, 2014), EMbase, CNKI, CBM and WanFang Data from the date of their establishment to April 2014. Other relevant journals and references of included studies were also searched manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2. Results A total of fifteen RCTs involving 2 268 patients were enrolled. The results of meta-analysis indicated that:a) for effectiveness, LTME and OTME were alike in resection length of the intestine (MD=-0.52, 95%CI-1.29 to 0.25, P=0.18), dissection number of lymph nodes (MD=-0.11, 95%CI-0.75 to 0.52, P=0.73), 1-year survival rate (RR=0.99, 95%CI 0.96 to 1.02, P=0.52), and 3-year survival rate (RR=0.99, 95%CI 0.93 to 1.04, P=0.63) with no significant difference. For safety, LTME had longer operation time (MD=29.64, 95%CI 14.90 to 44.39, P < 0.000 1); caused less intra-operative bleeding (MD=-105.51, 95%CI-133.95 to-77.08, P < 0.000 01); and shortened post-operative anal exsufflation time (MD=-0.99, 95%CI-1.35 to-0.62, P < 0.000 01), catheterization time (MD=-2.02, 95%CI-2.20 to-1.83, P < 0.000 01) as well as hospital stay (MD=-3.47, 95%CI-4.20 to-2.74, P < 0.000 01). Besides, LTME had less postoperative complications such as anastomotic leak (RR=0.67, 95%CI 0.37 to 1.22, P=0.19) and wound infection (RR=0.43, 95%CI 0.26 to 0.73, P=0.002). However, LTME and OTME were alike in the incidence of intestinal obstruction (RR=0.53, 95%CI 0.28 to 1.00, P=0.05). Conclusion Current evidence indicates that LTME and OTME are alike in effectiveness, but LTME could cause less bleeding, shorten time of catheterization, post-operative anal exsufflation and hospital stay with less post-operative complications. Due to the limited quantity and quality of the included studies, more larger sample, multicenter, high quality RCTs are needed to verify the above conclusion.

Citation： LIUZhou, DONGWei-guo, ZHANGJi-xiang, LIUYu-lan, WUDan-dan. Laparoscopic Total Mesorectal Excision versus Open Total Mesorectal Excision for Rectal Cancer: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(9): 1112-1118. doi: 10.7507/1672-2531.20140181 Copy

1.	Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA-Cancer J Clin, 2009, 59(4):225-249.
2.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA-Cancer J Clin, 2011, 61(2):69-90.
3.	Kvarnstr?m A, Sokolov A, Swartling T, et al. Alternative pathway activation of complement in laparoscopic and open rectal surgery. Scand J Immunol, 2012, 76(1):49-53.
4.	Jacobs M, Verdeja JC, Goldstein HS, et al. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3):144-150.
5.	Engstrom PF, Arnoletti JP, Benson AB, et al. NCCN Clinical Practice Guidelines in oncology:rectal cancer. Natl Compr Canc Netw, 2009, 7(8):838-881.
6.	何中華.傳統開腹與腹腔鏡直腸癌手術的臨床效果對比分析.中國醫藥指南, 2013, 11(2):473-474.
7.	范瑩.腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究.中國普外基礎與臨床雜志, 2009, 16(5):384-388.
8.	溫學文, 張彤, 羅勁根.腹腔鏡下直腸癌根治術與開腹手術的療效比較.廣州醫學, 2011, 32(10):1304-1306.
9.	Gong J, Shi DB, Li XX, et al. Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery. World J Gastroenterol, 2012, 18(48):7308-7313.
10.	陳加明, 蔡云輝, 楊留才, 等.腹腔鏡與開腹直腸癌根治術近期和遠期療效對比分析.結直腸肛門外科, 2011, 17(5):296-298.
11.	朱乃標, 陳光, 董米連, 等.腹腔鏡與開腹直腸癌根治術療效的臨床對比研究, 臨床醫學, 2007, 27(2):11-13.
12.	田夫, 向進見, 李明忠, 等.腹腔鏡與開腹直腸癌根治術臨床特點比較.湖北醫藥學院學報, 2011, 30(1):41-43.
13.	邱楓, 王今.腹腔鏡與開腹直腸癌手術近期療效對比.首都醫科大學學報, 2013, 34(5):689-692.
14.	黃甫達, 楊昌謀, 郭俊宇, 等.腹腔鏡直腸癌根治術與Dixon直腸癌根治術的臨床療效對比.世界華人消化雜志, 2014, 22(2):291-295.
15.	王斌.開腹手術與腹腔鏡治療直腸癌臨床比較分析.中國醫藥指南, 2010, 8(32):207-208.
16.	徐佳, 黃世鋒.腹腔鏡直腸癌手術與開腹直腸癌手術的療效對比研究.結直腸肛門外科, 2012, 18(4):236-239.
17.	Staudacher C, Vignali A, Saverio DP, et al. Laparoscopic vs open total mesorectal excision in unselected patients with rectal cancer:impact on early outcome. Dis Colon Rectum, 2007, 50(9):1324-1331.
18.	朱志強, 寧忠良, 梁偉, 等.腹腔鏡與開腹手術治療進展期直腸癌的療效比較.安徽醫科大學學報, 2010, 45(6):795-797.
19.	任克彥.經腹腔鏡下直腸癌根治術與開腹手術的近期療效比較.中國普通外科雜志, 2013, 22(3):374-376.
20.	Liang XB, Hou SH, Liu HY, et al. Effectiveness and safety of laparoscopic a randomized controlled trail from china. J Laparoendosco Adv Surg Tech, 2011, 21(5):381-385.
21.	Bosman FT, Cameiro F, Hruban RH, et al. World health organization classification of tumours of digestive system. Lyon:IARC Press, 2010.
22.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochranehandbook.org.
23.	Weeks JC, Nelson H, Gelber S, et al. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer:a randomized trial. JAMA, 2002, 287(3):321-328.
24.	鄭民華, 蔡景理, 陸愛國, 等.腹腔鏡手術治療直腸癌安全性的臨床研究.外科理論與實踐, 2009, 8(5):361-364.
25.	Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer:a meta-analysis. Ann Surg Oncol, 2006, 13(3):413-424.
26.	葉平紅, 郭貴龍, 應曉紅, 等.腹腔鏡與開腹結直腸癌根治術對機體免疫系統影響的比較研究.中國內鏡雜志, 2001, 17(5):478-480, 484.
27.	Lacy AM, Carcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastic colon cancer:a randomized trail. Lancet, 2002, 359(9325):22-42.
28.	Lujan J, Valero G, Hernandez Q, et al. Randomized clinical comparing Laparoscopic and open surgery in patients with rectal cancer. Br J Surg, 2009, 96(9):982-989.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA-Cancer J Clin, 2009, 59(4):225-249.
2. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA-Cancer J Clin, 2011, 61(2):69-90.
3. Kvarnstr?m A, Sokolov A, Swartling T, et al. Alternative pathway activation of complement in laparoscopic and open rectal surgery. Scand J Immunol, 2012, 76(1):49-53.
4. Jacobs M, Verdeja JC, Goldstein HS, et al. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3):144-150.
5. Engstrom PF, Arnoletti JP, Benson AB, et al. NCCN Clinical Practice Guidelines in oncology:rectal cancer. Natl Compr Canc Netw, 2009, 7(8):838-881.
6. 何中華.傳統開腹與腹腔鏡直腸癌手術的臨床效果對比分析.中國醫藥指南, 2013, 11(2):473-474.
7. 范瑩.腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究.中國普外基礎與臨床雜志, 2009, 16(5):384-388.
8. 溫學文, 張彤, 羅勁根.腹腔鏡下直腸癌根治術與開腹手術的療效比較.廣州醫學, 2011, 32(10):1304-1306.
9. Gong J, Shi DB, Li XX, et al. Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery. World J Gastroenterol, 2012, 18(48):7308-7313.
10. 陳加明, 蔡云輝, 楊留才, 等.腹腔鏡與開腹直腸癌根治術近期和遠期療效對比分析.結直腸肛門外科, 2011, 17(5):296-298.
11. 朱乃標, 陳光, 董米連, 等.腹腔鏡與開腹直腸癌根治術療效的臨床對比研究, 臨床醫學, 2007, 27(2):11-13.
12. 田夫, 向進見, 李明忠, 等.腹腔鏡與開腹直腸癌根治術臨床特點比較.湖北醫藥學院學報, 2011, 30(1):41-43.
13. 邱楓, 王今.腹腔鏡與開腹直腸癌手術近期療效對比.首都醫科大學學報, 2013, 34(5):689-692.
14. 黃甫達, 楊昌謀, 郭俊宇, 等.腹腔鏡直腸癌根治術與Dixon直腸癌根治術的臨床療效對比.世界華人消化雜志, 2014, 22(2):291-295.
15. 王斌.開腹手術與腹腔鏡治療直腸癌臨床比較分析.中國醫藥指南, 2010, 8(32):207-208.
16. 徐佳, 黃世鋒.腹腔鏡直腸癌手術與開腹直腸癌手術的療效對比研究.結直腸肛門外科, 2012, 18(4):236-239.
17. Staudacher C, Vignali A, Saverio DP, et al. Laparoscopic vs open total mesorectal excision in unselected patients with rectal cancer:impact on early outcome. Dis Colon Rectum, 2007, 50(9):1324-1331.
18. 朱志強, 寧忠良, 梁偉, 等.腹腔鏡與開腹手術治療進展期直腸癌的療效比較.安徽醫科大學學報, 2010, 45(6):795-797.
19. 任克彥.經腹腔鏡下直腸癌根治術與開腹手術的近期療效比較.中國普通外科雜志, 2013, 22(3):374-376.
20. Liang XB, Hou SH, Liu HY, et al. Effectiveness and safety of laparoscopic a randomized controlled trail from china. J Laparoendosco Adv Surg Tech, 2011, 21(5):381-385.
21. Bosman FT, Cameiro F, Hruban RH, et al. World health organization classification of tumours of digestive system. Lyon:IARC Press, 2010.
22. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochranehandbook.org.
23. Weeks JC, Nelson H, Gelber S, et al. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer:a randomized trial. JAMA, 2002, 287(3):321-328.
24. 鄭民華, 蔡景理, 陸愛國, 等.腹腔鏡手術治療直腸癌安全性的臨床研究.外科理論與實踐, 2009, 8(5):361-364.
25. Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer:a meta-analysis. Ann Surg Oncol, 2006, 13(3):413-424.
26. 葉平紅, 郭貴龍, 應曉紅, 等.腹腔鏡與開腹結直腸癌根治術對機體免疫系統影響的比較研究.中國內鏡雜志, 2001, 17(5):478-480, 484.
27. Lacy AM, Carcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastic colon cancer:a randomized trail. Lancet, 2002, 359(9325):22-42.
28. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical comparing Laparoscopic and open surgery in patients with rectal cancer. Br J Surg, 2009, 96(9):982-989.

Chinese Journal of Evidence-Based Medicine

Laparoscopic Total Mesorectal Excision versus Open Total Mesorectal Excision for Rectal Cancer: A Meta-Analysis

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