The short-term efficacy of laparoscopic transanal pull through surgery <i>versus</i> conventional laparoscopic surgery for rectal cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHEN Xiaobo ¹ , FENG Yan ²

1. Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;
2. Department of Anesthesiology, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

CHEN Xiaobo, Email: cxb64457@163.com

Keywords：

rectal cancer; laparoscopic transanal pull through surgery; conventional laparoscopic surgery; short-term efficacy; meta-analysis

DOI：

10.7507/1007-9424.201907088

Video：

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Objective To compare the short-term efficacy of laparoscopic transanal pull through surgery and conventional laparoscopic surgery for rectal cancer.Methods Relevant literatures were retrieved from databases including PubMed, Cochrane Library databases, Embase, CNKI, CBM, Wan-fang database, and VIP databases from Jan. 2009 to Jul. 2019, all the relevant trial documents ［included randomized controlled trial and non randomized controlled trial］ were collected for comparison of laparoscopic transanal pull through surgery and conventional laparoscopic surgery on the clinical efficacy of rectal cancer patients, the qualified literatures were screened in strict accordance with inclusion and exclusion criteria, and Stata12.0 software was used for statistical analysis.Results A total of 19 articles were included in the literature with 2 683 patients were included among them. Meta analysis results showed that, compared with the conventional laparoscopic surgery group, in laparoscopic transanal pull through surgery group, operation time [WMD=–6.78, 95% CI was (–11.96, –1.60), P<0.01], intraoperative blood loss [WMD=–14.94, 95% CI was (–23.48, –6.40),P<0.01], postoperative exhaust time [WMD=–13.55, 95% CI was (–18.24, –8.85), P<0.01], postoperative hospitalization time [WMD=–1.60, 95% CI was (–2.00, –1.21), P<0.01], incidence of postoperative overall complication [OR=0.50, 95% CI was (0.38, 0.67), P<0.01], and incidence of incision infection [OR=0.19, 95% CI was (0.08, 0.45), P<0.01] reduced. Those differences were not significant, such as intraoperative lymph node resection [WMD=–0.02, 95% CI was (–0.44, 0.40), P=0.92], incision margin distance of tumor [WMD=0.13, 95% CI was (–0.30, 0.55), P=0.56], and incidence of anastomotic fistula [OR=0.97, 95% CI was (0.62, 1.50), P=0.87].Conclusions Laparoscopic transanal pull through surgery has more safe, effective, and reliable effects than conventional laparoscopic surgery for rectal cancer. It has further research value, but there may be inevitable bias and other effects in the included literatures, so more randomized controlled clinical trials are needed in the future.

Citation： CHEN Xiaobo, FENG Yan. The short-term efficacy of laparoscopic transanal pull through surgery versus conventional laparoscopic surgery for rectal cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(4): 464-475. doi: 10.7507/1007-9424.201907088 Copy

1.	Karachun AM, Petrova EA, Pelipas YV, et al. Laparoscopic surgery for rectal cancer: a literature review and own experience. Vopr Onkol, 2015, 61(6): 861-866.
2.	Parker JM, Feldmann TF, Cologne KG. Advances in laparoscopic colorectal surgery. Surg Clin North Am, 2017, 97(3): 547-560.
3.	周海涛, 周志祥, 梁建伟, 等. 无切口腹腔镜下直肠外翻技术的直肠癌低位前切除术的近期疗效. 中华肿瘤杂志, 2015, 37(1): 63-66.
4.	Shimizu H, Adachi K, Ohtsuka H, et al. Totally laparoscopic resection for low sigmoid and rectal cancer using natural orifice specimen extraction techniques. Surg Laparosc Endosc Percutan Tech, 2017, 27(4): e74-e79.
5.	李琦, 洪潮, 沈黎辉, 等. 运用 Cochrane 评价系统的方法评价针灸疗法治疗神经根型颈椎病的疗效. 实用临床医药杂志, 2015, 19(z1): 82-83.
6.	许凌, 尤庆生, 林雷, 等. 主动脉弓部夹层动脉瘤治疗方法的 Meta 分析. 老年医学与保健, 2018, 24(4): 454-460.
7.	黄顺荣, 冯泽荣, 秦千子, 等. 完全腹腔镜与腹腔镜辅助直肠癌保肛手术近期疗效比较的研究. 广西医科大学学报, 2009, 26(1): 113-115.
8.	陈开运, 向国安, 王汉宁, 等. 免辅助切口腹腔镜手术治疗低位直肠癌. 中华普通外科杂志, 2010, 25(2): 137-140.
9.	王德举, 周志明, 孟宪春, 等. 腹腔镜辅助下直肠外翻拖出式手术在中低位直肠癌治疗中的无瘤技术与临床价值. 河北医科大学学报, 2012, 33(1): 39-41.
10.	姚寒晖, 黄强, 宁忠良, 等. 经肛拖出式全腹腔镜直肠前切除同腹腔镜辅助直肠前切除对比研究. 安徽医科大学学报, 2014, 49(5): 676-678.
11.	Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol, 2014, 20(44): 16707-16713.
12.	汪春良, 袁航, 许映, 等. 腹腔镜中低位直肠癌经肛拖出切除 92 例疗效观察. 中华胃肠外科杂志, 2014, 17(8): 836-838.
13.	Zhang X, Zhou H, Liang J, et al. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis, 2014, 29(9): 1119-1124.
14.	余思, 邓建中, 计勇, 等. 改良式经肛门取标本技术在腹腔镜直肠前切除术治疗低位乙状结肠或高位直肠癌中的应用. 中华普通外科学文献: 电子版, 2016, 10(4): 264-267, 290.
15.	张永康, 张剑, 廖晓锋. 腹腔镜下直肠经肛门拖出式手术与直肠前切除术治疗低位直肠癌的比较. 中国微创外科杂志, 2016, 16(8): 736-739.
16.	林恒军, 邱学科, 袁航. 经肛拖出式全腹腔镜直肠癌前切除在直肠癌患者中的临床价值. 中国内镜杂志, 2017, 23(1): 1-5.
17.	赵泽峰, 杨之斌. 经肛门拖出式全腔镜直肠前切除术治疗中低位直肠癌效果观察. 山东医药, 2017, 57(34): 53-55.
18.	黄亮, 余壮明, 李军, 等. 腹部无切口腹腔镜低位直肠癌前切除经肛门取出标本的临床分析. 中华普外科手术学杂志: 电子版, 2017, 11(3): 237-239.
19.	苏松盛, 何进达, 曾凡英. 腹腔镜下无腹部切口直肠癌切除经肛门外翻拖出吻合临床分析. 中华普外科手术学杂志: 电子版, 2017, 11(3): 233-236.
20.	张钧. 腹部无辅助切口腹腔镜直肠癌根治术的效果分析. 中华普外科手术学杂志: 电子版, 2017, 11(4): 298-301.
21.	梁平. 腹腔镜下直肠低位前切除术与直肠经肛门拖出切除术治疗直肠癌的效果比较. 中华普外科手术学杂志: 电子版, 2018, 12(1): 46-48.
22.	Park JS, Kang H, Park SY, et al. Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study. Ann Surg Treat Res, 2018, 94(1): 26-35.
23.	Liu Z, Efetov S, Guan X, et al. A multicenter study evaluating natural orifice specimen extraction surgery for rectal cancer. J Surg Res, 2019, 243: 236-241.
24.	Hu JH, Li XW, Wang CY, et al. Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer. World J Clin Cases, 2019, 7(2): 122-129.
25.	李瑞生, 胡滨, 张富, 等. 改良无辅助切口完全腹腔镜全直肠系膜切除术治疗直肠癌的疗效. 中国微创外科杂志, 2019, 19(1): 46-49.
26.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
27.	刘海军, 刘清安, 陈新文, 等. 腹腔镜和开腹手术联合同步新辅助放化疗治疗进展期直肠癌的近期疗效比较. 中国肿瘤外科杂志, 2013, 5(1): 37-39.
28.	Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol, 2014, 20(36): 12981-12992.
29.	D’Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis, 2011, 13(Suppl 7): 28-31.
30.	Zhang H, Cong JC, Ling YZ, et al. Laparoscopic low anterior resection of the rectum with transanal prolapsing specimen extraction: early experience with 23 patients. J Laparoendosc Adv Surg Tech A, 2016, 26(5): 379-385.
31.	成昌霞, 周学颖, 李福玮, 等. 手术时间对手术切口感染影响的研究. 中华医院感染学杂志, 2016, 26(5): 1111-1112, 1123.
32.	杨玉波, 关铁军, 王斌, 等. 直肠癌手术切口感染的危险因素分析与预防对策. 中华医院感染学杂志, 2015, 25(1): 184-186.

1. Karachun AM, Petrova EA, Pelipas YV, et al. Laparoscopic surgery for rectal cancer: a literature review and own experience. Vopr Onkol, 2015, 61(6): 861-866.
2. Parker JM, Feldmann TF, Cologne KG. Advances in laparoscopic colorectal surgery. Surg Clin North Am, 2017, 97(3): 547-560.
3. 周海涛, 周志祥, 梁建伟, 等. 无切口腹腔镜下直肠外翻技术的直肠癌低位前切除术的近期疗效. 中华肿瘤杂志, 2015, 37(1): 63-66.
4. Shimizu H, Adachi K, Ohtsuka H, et al. Totally laparoscopic resection for low sigmoid and rectal cancer using natural orifice specimen extraction techniques. Surg Laparosc Endosc Percutan Tech, 2017, 27(4): e74-e79.
5. 李琦, 洪潮, 沈黎辉, 等. 运用 Cochrane 评价系统的方法评价针灸疗法治疗神经根型颈椎病的疗效. 实用临床医药杂志, 2015, 19(z1): 82-83.
6. 许凌, 尤庆生, 林雷, 等. 主动脉弓部夹层动脉瘤治疗方法的 Meta 分析. 老年医学与保健, 2018, 24(4): 454-460.
7. 黄顺荣, 冯泽荣, 秦千子, 等. 完全腹腔镜与腹腔镜辅助直肠癌保肛手术近期疗效比较的研究. 广西医科大学学报, 2009, 26(1): 113-115.
8. 陈开运, 向国安, 王汉宁, 等. 免辅助切口腹腔镜手术治疗低位直肠癌. 中华普通外科杂志, 2010, 25(2): 137-140.
9. 王德举, 周志明, 孟宪春, 等. 腹腔镜辅助下直肠外翻拖出式手术在中低位直肠癌治疗中的无瘤技术与临床价值. 河北医科大学学报, 2012, 33(1): 39-41.
10. 姚寒晖, 黄强, 宁忠良, 等. 经肛拖出式全腹腔镜直肠前切除同腹腔镜辅助直肠前切除对比研究. 安徽医科大学学报, 2014, 49(5): 676-678.
11. Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol, 2014, 20(44): 16707-16713.
12. 汪春良, 袁航, 许映, 等. 腹腔镜中低位直肠癌经肛拖出切除 92 例疗效观察. 中华胃肠外科杂志, 2014, 17(8): 836-838.
13. Zhang X, Zhou H, Liang J, et al. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis, 2014, 29(9): 1119-1124.
14. 余思, 邓建中, 计勇, 等. 改良式经肛门取标本技术在腹腔镜直肠前切除术治疗低位乙状结肠或高位直肠癌中的应用. 中华普通外科学文献: 电子版, 2016, 10(4): 264-267, 290.
15. 张永康, 张剑, 廖晓锋. 腹腔镜下直肠经肛门拖出式手术与直肠前切除术治疗低位直肠癌的比较. 中国微创外科杂志, 2016, 16(8): 736-739.
16. 林恒军, 邱学科, 袁航. 经肛拖出式全腹腔镜直肠癌前切除在直肠癌患者中的临床价值. 中国内镜杂志, 2017, 23(1): 1-5.
17. 赵泽峰, 杨之斌. 经肛门拖出式全腔镜直肠前切除术治疗中低位直肠癌效果观察. 山东医药, 2017, 57(34): 53-55.
18. 黄亮, 余壮明, 李军, 等. 腹部无切口腹腔镜低位直肠癌前切除经肛门取出标本的临床分析. 中华普外科手术学杂志: 电子版, 2017, 11(3): 237-239.
19. 苏松盛, 何进达, 曾凡英. 腹腔镜下无腹部切口直肠癌切除经肛门外翻拖出吻合临床分析. 中华普外科手术学杂志: 电子版, 2017, 11(3): 233-236.
20. 张钧. 腹部无辅助切口腹腔镜直肠癌根治术的效果分析. 中华普外科手术学杂志: 电子版, 2017, 11(4): 298-301.
21. 梁平. 腹腔镜下直肠低位前切除术与直肠经肛门拖出切除术治疗直肠癌的效果比较. 中华普外科手术学杂志: 电子版, 2018, 12(1): 46-48.
22. Park JS, Kang H, Park SY, et al. Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study. Ann Surg Treat Res, 2018, 94(1): 26-35.
23. Liu Z, Efetov S, Guan X, et al. A multicenter study evaluating natural orifice specimen extraction surgery for rectal cancer. J Surg Res, 2019, 243: 236-241.
24. Hu JH, Li XW, Wang CY, et al. Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer. World J Clin Cases, 2019, 7(2): 122-129.
25. 李瑞生, 胡滨, 张富, 等. 改良无辅助切口完全腹腔镜全直肠系膜切除术治疗直肠癌的疗效. 中国微创外科杂志, 2019, 19(1): 46-49.
26. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
27. 刘海军, 刘清安, 陈新文, 等. 腹腔镜和开腹手术联合同步新辅助放化疗治疗进展期直肠癌的近期疗效比较. 中国肿瘤外科杂志, 2013, 5(1): 37-39.
28. Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol, 2014, 20(36): 12981-12992.
29. D’Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis, 2011, 13(Suppl 7): 28-31.
30. Zhang H, Cong JC, Ling YZ, et al. Laparoscopic low anterior resection of the rectum with transanal prolapsing specimen extraction: early experience with 23 patients. J Laparoendosc Adv Surg Tech A, 2016, 26(5): 379-385.
31. 成昌霞, 周学颖, 李福玮, 等. 手术时间对手术切口感染影响的研究. 中华医院感染学杂志, 2016, 26(5): 1111-1112, 1123.
32. 杨玉波, 关铁军, 王斌, 等. 直肠癌手术切口感染的危险因素分析与预防对策. 中华医院感染学杂志, 2015, 25(1): 184-186.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The short-term efficacy of laparoscopic transanal pull through surgery versus conventional laparoscopic surgery for rectal cancer: a meta-analysis

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