Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis |
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Authors: | Omer Aziz MRCS BSc Vasilis Constantinides MBBS Paris P Tekkis MD FRCS Thanos Athanasiou PhD FECTS Sanjay Purkayastha MRCS BSc Paraskevas Paraskeva PhD FRCS Ara W Darzi FRCS KBE Alexander G Heriot MD FRCS |
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Institution: | (1) Department of Surgical Oncology & Technology, Imperial College London, St. Mary’s Hospital, 10th Floor QEQM Wing, Praed Street, London, W2 1NY, United Kingdom |
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Abstract: | Background Laparoscopic rectal cancer surgery aims to provide patients with curative resection while minimizing postoperative morbidity
and mortality. This study used meta-analytical techniques to compare laparoscopic and open surgery as the primary treatment
for patients with rectal cancer with regard to short-term and long-term outcomes.
Methods A literature search was performed on all studies between 1993 and 2004 comparing laparoscopic and open surgery for rectal
cancer. Subgroup analysis was performed on patients undergoing abdominoperineal excision of the rectum. The following end
points were evaluated: operative outcomes, postoperative recovery, and early and late adverse events.
Results Twenty studies matched the selection criteria and reported on 2071 subjects, of whom 909 (44%) underwent laparoscopic and
1162 (56%) underwent open surgery for rectal cancer. Time to stomal function (weighted mean difference WMD], −1.52; 95% confidence
interval 95% CI], −2.20, −1.01), first bowel movement (WMD, −.72; 95% CI, −1.21, −.22), feeding solids (WMD, −.92; 95% CI,
−1.35, −.50), and length of hospital stay (WMD, −2.67; 95% CI, −3.81, −1.54) were all significantly reduced after laparoscopic
surgery. In patients who underwent abdominoperineal excision of the rectum, wound infection (odds ratio, .15; 95% CI, .03,
.73) and requirement for postoperative parenteral analgesia (WMD, −.63; 95% CI, −1.22, −.04) were also significantly reduced.
There was no difference between groups in the extent of oncological clearance.
Conclusions Laparoscopic rectal cancer surgery results in an earlier postoperative recovery and a resected specimen that is oncologically
comparable to open surgery. Results from randomized trials reporting long-term outcomes such as cancer recurrence (local and
metastatic) and 5-year survival are eagerly awaited. |
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Keywords: | Laparoscopic Rectal cancer Curative resection Comparative |
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