Laparoscopic Versus Open Surgery Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: a Systematic Review and Meta-analysis

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• 作者：Hao Chen (1)
  Liying Zhao (1)
  Shengli An (2)
  Jiaming Wu (1)
  Zhenhong Zou (1)
  Hao Liu (1)
  Guoxin Li (1)
  
• 关键词：Neoadjuvant chemoradiotherapy ; Rectal cancer ; Laparoscopic surgery ; Open surgery ; Meta ; analysis
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：18
• 期：3
• 页码：617-626
• 全文大小：551 KB
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• 作者单位：Hao Chen (1)
  Liying Zhao (1)
  Shengli An (2)
  Jiaming Wu (1)
  Zhenhong Zou (1)
  Hao Liu (1)
  Guoxin Li (1)
  
  1. Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, China
  2. Department of Biostatistics, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, China
  
• ISSN：1873-4626

文摘

Background This meta-analysis aimed to evaluate the short-term and pathological outcomes of laparoscopic surgery (LS) versus open surgery (OS) following neoadjuvant chemoradiotherapy (NCRT) for rectal cancer. Methods PubMed, Embase, Web of Science, Cochrane Library, and Chinese Biomedicine Literature databases were searched for eligible studies published up to July 2013. The rates of postoperative complication, positive circumferential resection margin (CRM), and the number of lymph nodes harvested were evaluated. Results Three randomized controlled trials (RCTs) and five non-RCTs enrolling 953 patients were included. Compared to OS, LS had similar rate of postoperative complication [odds ratio (OR) 0.86; 95?% confidence interval (CI), 0.60 to 1.22], comparable rate of positive CRM (OR 0.41; 95?% CI, 0.16 to 1.02), and smaller number of lymph nodes (weighted mean difference ?.8; 95?% CI, ?.1 to ?.5). LS also had significantly less blood loss, faster bowel movement recovery, and shorter postoperative hospitalization than those of OS. Conclusion LS is associated with favorable short-term benefits, similar postoperative complication rate, and comparable pathological outcomes for rectal cancer after NCRT compared to OS despite a slight difference in the number of lymph nodes. Additional high-quality studies are needed to validate long-term outcomes of LS following NCRT.