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.	Kvarnström 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.	何中华.传统开腹与腹腔镜直肠癌手术的临床效果对比分析.中国医药指南, 2013, 11(2):473-474.
7.	范莹.腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究.中国普外基础与临床杂志, 2009, 16(5):384-388.
8.	温学文, 张彤, 罗劲根.腹腔镜下直肠癌根治术与开腹手术的疗效比较.广州医学, 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.	陈加明, 蔡云辉, 杨留才, 等.腹腔镜与开腹直肠癌根治术近期和远期疗效对比分析.结直肠肛门外科, 2011, 17(5):296-298.
11.	朱乃标, 陈光, 董米连, 等.腹腔镜与开腹直肠癌根治术疗效的临床对比研究, 临床医学, 2007, 27(2):11-13.
12.	田夫, 向进见, 李明忠, 等.腹腔镜与开腹直肠癌根治术临床特点比较.湖北医药学院学报, 2011, 30(1):41-43.
13.	邱枫, 王今.腹腔镜与开腹直肠癌手术近期疗效对比.首都医科大学学报, 2013, 34(5):689-692.
14.	黄甫达, 杨昌谋, 郭俊宇, 等.腹腔镜直肠癌根治术与Dixon直肠癌根治术的临床疗效对比.世界华人消化杂志, 2014, 22(2):291-295.
15.	王斌.开腹手术与腹腔镜治疗直肠癌临床比较分析.中国医药指南, 2010, 8(32):207-208.
16.	徐佳, 黄世锋.腹腔镜直肠癌手术与开腹直肠癌手术的疗效对比研究.结直肠肛门外科, 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.	朱志强, 宁忠良, 梁伟, 等.腹腔镜与开腹手术治疗进展期直肠癌的疗效比较.安徽医科大学学报, 2010, 45(6):795-797.
19.	任克彦.经腹腔镜下直肠癌根治术与开腹手术的近期疗效比较.中国普通外科杂志, 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.	郑民华, 蔡景理, 陆爱国, 等.腹腔镜手术治疗直肠癌安全性的临床研究.外科理论与实践, 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.	叶平红, 郭贵龙, 应晓红, 等.腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究.中国内镜杂志, 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. Kvarnström 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. 何中华.传统开腹与腹腔镜直肠癌手术的临床效果对比分析.中国医药指南, 2013, 11(2):473-474.
7. 范莹.腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究.中国普外基础与临床杂志, 2009, 16(5):384-388.
8. 温学文, 张彤, 罗劲根.腹腔镜下直肠癌根治术与开腹手术的疗效比较.广州医学, 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. 陈加明, 蔡云辉, 杨留才, 等.腹腔镜与开腹直肠癌根治术近期和远期疗效对比分析.结直肠肛门外科, 2011, 17(5):296-298.
11. 朱乃标, 陈光, 董米连, 等.腹腔镜与开腹直肠癌根治术疗效的临床对比研究, 临床医学, 2007, 27(2):11-13.
12. 田夫, 向进见, 李明忠, 等.腹腔镜与开腹直肠癌根治术临床特点比较.湖北医药学院学报, 2011, 30(1):41-43.
13. 邱枫, 王今.腹腔镜与开腹直肠癌手术近期疗效对比.首都医科大学学报, 2013, 34(5):689-692.
14. 黄甫达, 杨昌谋, 郭俊宇, 等.腹腔镜直肠癌根治术与Dixon直肠癌根治术的临床疗效对比.世界华人消化杂志, 2014, 22(2):291-295.
15. 王斌.开腹手术与腹腔镜治疗直肠癌临床比较分析.中国医药指南, 2010, 8(32):207-208.
16. 徐佳, 黄世锋.腹腔镜直肠癌手术与开腹直肠癌手术的疗效对比研究.结直肠肛门外科, 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. 朱志强, 宁忠良, 梁伟, 等.腹腔镜与开腹手术治疗进展期直肠癌的疗效比较.安徽医科大学学报, 2010, 45(6):795-797.
19. 任克彦.经腹腔镜下直肠癌根治术与开腹手术的近期疗效比较.中国普通外科杂志, 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. 郑民华, 蔡景理, 陆爱国, 等.腹腔镜手术治疗直肠癌安全性的临床研究.外科理论与实践, 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. 叶平红, 郭贵龙, 应晓红, 等.腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究.中国内镜杂志, 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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