报告首次也是最大的系统评价和荟萃分析,以比较经肛门内镜显微手术(TEM)和全直肠系膜切除术(TME)对直肠癌围手术期和肿瘤学结果的疗效和安全性。方法:我们通过PubMed进行了系统的文献检索,Embase,WebofScience,和Cochrane,直到2022年12月进行RCT,评估TEM和TME对直肠癌的疗效和/或安全性。结果包括手术时间,失血,输血率,住院,并发症发生率,复发率,和死亡率。结果:共有5个RCTs,涉及545例患者(272例TEM和273例TME)被纳入荟萃分析。两组之间的年龄没有显着差异,性别,以及肿瘤下边界到肛门边缘的距离。Meta分析发现,TEM组的失血量明显优于TME组(WMD:172.01;95%CI:212.78,-131.24;P<0.00001),住院时间(WMD:2.58;95%CI:3.01,-2.16;P<0.00001),手术时间(WMD:81.86;95%CI:87.51,-76.21;P<0.00001)和输血率(RR:0.05;95%CI:0.01,0.38;P=0.004)。并发症发生率(RR:0.60;95%CI:0.32,1.11;P=0.10),复发率(RR:1.10;95%CI:0.66,1.83;P=0.72),两组患者的死亡率(RR:1.23;95%CI:0.67,2.26;P=0.51)相似.结论:与TME方法相比,TEM是一种有效且安全的方法,在围手术期结局方面具有优势。由于明显的异质性和不稳定性,在解释TEM和TME组之间手术并发症的差异时应谨慎。
To report the first and largest systematic
review and meta-analysis of radomised controlled trials (RCTs) to compare the efficacy and safety of transanal endoscopic microsurgery (TEM) and total mesorectal excision (
TME) for rectal cancer for perioperative and oncological outcomes. Methods: We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until December 2022 for RCTs which evaluated the efficacy and/or safety between TEM and
TME for rectal cancer. Outcomes included operative time, blood loss, transfusion rates, hospital stay, complication rates, recurrence rates, and mortality. Results: A total of 5 RCTs involving 545 patients (272 TEM versus 273 TME) were included for the meta-analysis. There were no significant differences between the two groups for age, gender, and distance from lower border of tumor to anal verge. Meta-analysis found that the TEM group was significantly favorable than the
TME group for blood loss (WMD: 172.01; 95 % CI: 212.78, -131.24; P < 0.00001), hospital stay (WMD: 2.58; 95 % CI: 3.01, -2.16; P < 0.00001), operative time (WMD: 81.86; 95 % CI: 87.51, -76.21; P < 0.00001) and transfusion rates (RR: 0.05; 95 % CI: 0.01, 0.38; P = 0.004). The complication rates (RR: 0.60; 95 % CI: 0.32, 1.11; P = 0.10), recurrence rates (RR: 1.10; 95 % CI: 0.66, 1.83; P = 0.72), and mortality (RR: 1.23; 95 % CI: 0.67, 2.26; P = 0.51) were similar in the two groups. Conclusions: TEM was an effective and safe approach with advantages in perioperative outcomes compared with TME approach. Caution should be exercised in interpreting the differences in surgical complications between TEM and
TME group due to significant heterogeneity and instability.