全直肠系膜切除术对比传统手术治疗直肠癌的荟萃分析

目的研究比较全直肠系膜切除术(TME)和传统手术(CRS)治疗直肠癌的疗效。方法以直肠癌、TME为检索词。检索MEDLINE数据库1986年1月至2006年5月间发表的有关TME对比传统手术治疗直肠癌的文献。按筛选标准。共有17篇文献入选。由2名作者各自独立地对人选文献中有关试验设计、研究对象的特征、研究结果等内容进行摘录,并用RevMan 4.2软件进行统计分析。结果全体研究样本量共计5267例直肠癌。定性分析全体研究结果显示:TME组术后局部复发率均显著低于CRS组。全体研究、前瞻性研究(前瞻性非随机研究和前瞻性多中心非随机研究)及回顾性研究的定量分析结果均显示:TME组治疗直肠癌术后局部复发率比CRS组显著降低,而术后生存率则显著提高。局部复发率合并优势比(OR)分别为0.35(95%CI 0.29-0.43,P<0.00001)、0.41(95%CI 0.32～0.53,P<0.00001)及0.29(95%CI 0.22～0.39,P<0.00001);术后生存率合并OR分别为1.81(95%CI 1.55～2.11,P<0.00001)、1.79(95%CI 1.49～2.15,P<0.00001)及1.84(95%CI 1.39～2.45,P<0.00001)。全体研究、前瞻性研究分析结果均显示:TME组对比CRS组可显著降低患者术后死亡率,合并OR分别为0.51(95%CI 0.32～0.83,P= 0.007)及0.56(95%CI 0.33～0.97,P=0.04);而回顾性研究的定量分析则显示:在术后死亡率方面TME组与CRS组差异无统计学意义,合并OR为0.39(95%CI 0.14～1.10,P=0.07)。全体研究、前瞻性研究分析均显示:TME手术是导致吻合口瘘发生的高危因素.但与CRS组比较差异无统计学意义,合并OR分别为1.24(95%CI 0.84～1.83,P=0.29)、1.98(95%CI 0.85～4.61,P=0.11)。结论TME是目前治疗直肠癌的标准术式,它比传统直肠癌根治术明显降低术后局部复发率、提高生存率。

Total mesorectal excision versus conventional radical surgery for rectal cancer: a Meta analysis

OBJECTIVE: To compare treatment outcomes of total mesorectal excision (TME) with those of conventional radical surgery (CRS) for rectal cancer. METHODS: Literature reviews were performed with key words, such as rectal cancer, total mesorectal excision, TME on all studies reported on TME versus CRS for rectal cancer between January 1986 to May 2006. According to the same screening criteria, 17 clinical studies were included in our systematic reviews. Two of our co-authors drew the details of trial design, characteristics of participants, results and so on from the studies included. Data analyses were performed by using RevMan 4.2. RESULTS: Sample volume in this Meta analysis was 5267 rectal cancer cases. Quality and quantity analyses were performed within all included studies, prospective studies (prospective nonrandomized studies and multicenter prospective nonrandomized studies) and retrospective studies. The results showed that postoperative survival rate was significantly increased OR 1.81 (95%CI 1.55-2.11, P<0.00001), OR 1.79 (95%CI 1.49-2.15, P<0.00001) and OR 1.84 (95%CI 1.39-2.45, P<0.00001)] and local recurrence rate was significantly reduced OR 0.35 (95%CI 0.29-0.43, P<0.00001), OR 0.41 (95%CI 0.32-0.53, P<0.00001) and OR 0.29 (95%CI 0.22-0.39, P<0.00001)] after TME was used. The results of all study analyses agreed with those from prospective studies analyses, in which postoperative mortality was significantly reduced OR 0.51 (95%CI 0.32-0.87, P=0.007) and OR 0.56 (95%CI 0.33-0.94, P=0.04)] after TME treatment, meanwhile the results of retrospective study analyses indicated that there was no significant difference between TME group and CRS group in postoperative mortality OR 0.39 (95%CI 0.14-1.10, P=0.07)]. TME was a risk factor for postoperative anastomotic leak according to the results of all included studies and prospective study analyses, but no difference between TME group and CRS group had been found OR 1.24 (95%CI 0.84-1.83, P=0.29) OR 1.98 (95%CI 0.85-4.61, P=0.11)]. CONCLUSIONS: TME is still the standard operative technique for rectal cancer. As compared with CRS, TME results in lower postoperative local recurrence rate and higher survival rate.