Laparoscopic surgery for rectal cancer is not superior to open surgery in long⁃term efficacy:a Meta⁃analysis of classic randomized controlled trials in the last 10 years
Objective:To present a meta-analysis of high-quality published and classic randomized controlled trials(RCTs)in the past decade in comparison to laparoscopic surgery(LS)and open surgery(OS)for rectal cancer. Methods:Electronic literature search was performed on PubMed,EMBASE,Web of Science,OVID,CNKI,Wanfang Data and Cochrane Library from January 1,2007 to November 1,2018. All eligible RCTs were evaluated based on the Jadad score. We used the fixed effect model(FE)and the random effect model(RE)to analyze this cohort. Results:Among all the 14 included studies,a total of 3 288 cases were reported,including 1 779 patients in the LS group and 1 509 patients in the OS group. The results of the Meta-analysis demonstrated the operative time of the LS group was obviously longer than that of the OS group(MD=40.04,95%CI[24.07,56.01],P < 0.05),LS was associated with less blood loss(MD=-98.48,95%CI[-148.72,-48.25],P < 0.05),fewer blood transfusions(OR=0.30,95%CI[0.16,0.55],P < 0.05),shorter bowel function recovery times(MD=-0.68,95%CI[-0.98,-0.38],P < 0.05),shorter postoperative hospital stays(MD=-1.08,95%CI[-1.49,-0.66],P < 0.05),fewer postoperative complications(OR=0.67,95%CI[0.46,0.97],P < 0.05)and fewer wound infections(OR=0.52,95%CI[0.36,0.77],P < 0.05). However,no significant differences between the LS and OS groups were proximal resection margin,radial distal margin,the number of harvested lymph nodes,positive circumferential resection margin(CRM),reoperation,other postoperative complications(ileus,abdominal infection,lung infection,anastomotic fistula,anastomosis bleeding and anastomosis stenosis),local recurrence,3-year overall survival,5-year overall survival or 5-year disease-free survival. Conclusion:There are no significant differences between LS and OS in terms of the number of harvested lymph nodes,positive CRM,local recurrence or overall survival. More,LS for rectal cancer appears to be safer in blood loss,blood transfusions,bowel function recovery times and wound infections in comparison to OS.