PDF(Pubmed)
Abstract：
BACKGROUND: Laparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery.
OBJECTIVE: We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery.
METHODS: Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups.
RESULTS: Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches.
CONCLUSIONS: Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
OBJECTIVE: We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery.
METHODS: Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups.
RESULTS: Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches.
CONCLUSIONS: Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
摘要：
背景：腹腔镜手术已得到结肠癌临床指南的认可，但不适用于直肠癌，原因是未经批准的肿瘤学与开放手术相当。
目的：我们开始了这项迄今为止最大的荟萃分析，以全面评估腹腔镜与开腹手术相比在直肠癌治疗中的安全性和有效性。
方法：在PubMed中搜索了1990年1月至2020年3月之间比较腹腔镜直肠切除术和开腹手术的随机和非随机对照试验，Cochrane图书馆和Embase数据库（PROSPERO注册号CRD42020211718）。术中的数据，病态,比较两组患者术后和生存结果.
结果：20个RCT和93个NRCT，包括216,615名患者符合纳入标准，其中48,888例患者接受腹腔镜手术,167,727例患者接受开腹手术.与开放手术相比,腹腔镜手术组恢复较快,30天内并发症少，死亡率降低。腹腔镜手术组环周切缘(RR=0.79,95%CI:0.72~0.85,p<0.0001)和远切缘(RR=0.75,95%CI:0.66~0.85p<0.0001)阳性率显著降低,但全直肠系膜切除的完整性无显著差异。3年和5年局部复发，腹腔镜手术组的无病生存率和总生存率均有所提高，而两种方法之间的远端复发没有显着差异。
结论：在肿瘤学结果和长期生存率方面，腹腔镜检查在直肠癌治疗中不劣于开腹手术。此外，腹腔镜手术提供了短期优势，包括更快的恢复和更少的并发症。
目的：我们开始了这项迄今为止最大的荟萃分析，以全面评估腹腔镜与开腹手术相比在直肠癌治疗中的安全性和有效性。
方法：在PubMed中搜索了1990年1月至2020年3月之间比较腹腔镜直肠切除术和开腹手术的随机和非随机对照试验，Cochrane图书馆和Embase数据库（PROSPERO注册号CRD42020211718）。术中的数据，病态,比较两组患者术后和生存结果.
结果：20个RCT和93个NRCT，包括216,615名患者符合纳入标准，其中48,888例患者接受腹腔镜手术,167,727例患者接受开腹手术.与开放手术相比,腹腔镜手术组恢复较快,30天内并发症少，死亡率降低。腹腔镜手术组环周切缘(RR=0.79,95%CI:0.72~0.85,p<0.0001)和远切缘(RR=0.75,95%CI:0.66~0.85p<0.0001)阳性率显著降低,但全直肠系膜切除的完整性无显著差异。3年和5年局部复发，腹腔镜手术组的无病生存率和总生存率均有所提高，而两种方法之间的远端复发没有显着差异。
结论：在肿瘤学结果和长期生存率方面，腹腔镜检查在直肠癌治疗中不劣于开腹手术。此外，腹腔镜手术提供了短期优势，包括更快的恢复和更少的并发症。
