Comparison of clinical efficacy of laparoscopy and open surgeries for rectal cancer after neoadjuvant chemoradiotherapy in China: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HOU Songlin ^1,2 , LIU Daizhi ^1,2 , JIANG Xianhong ² , LIAO Hailing ¹ , YANG Song ¹ , CHEN Xiaobo ² , LI Lifa ² , ZHANG Guangjun ^1,2 ,  ZHOU Tong ^1,2

1. Institute of Hepatobiliary Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. The Second Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

ZHOU Tong, Email: zhoutong0088@163.com

Keywords：

neoadjuvant chemoradiotherapy; laparoscopy; open surgery; rectal cancer; meta-analysis

DOI：

10.7507/1007-9424.201711027

Video：

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Objective To compare efficacy of laparoscopic surgery and open surgery in treatment of rectal cancer after neoadjuvant chemoradiotherapy. Methods The relevant literatures were retrieved from databases including CNKI, CBM, Wanfang, VIP, PubMed, Cochrane Library, and Embase from 2007 to 2017, all the relevant randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) of laparoscopic surgery versus open surgery in patients with rectal cancer were collected according to the inclusion and exclusion criterial. Two reviewers independently screened the literatures, extracted the data, and assessed the bias risk of the included studies. Then, the meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs and 9 NRCTs involving 2 036 patients with rectal cancer were included, of these, including 1 021 cases of laparoscopic surgery and 1 015 cases of open surgery. The results of the meta-analysis showed that the operation time was increased ［WMD=14.21, 95% CI (1.92, 26.51)］, the intraoperative blood loss ［WMD=–38.96, 95% CI (–60.29, –7.63)］, first postoperative exhaust time ［WMD=–0.86, 95% CI (–1.14, –0.57)］, first postoperative intake food time ［WMD=–0.89, 95% CI (–1.15, –0.62)］, and postoperative hospitalization time ［WMD=–2.38, 95% CI (–3.44, –1.32)］ were reduced in the laparoscopic surgery as compared with the open surgery; the rate of the sphincter-saving was increased ［OR=2.35, 95% CI (1.67, 3.30)］, the rates of the local recurrence ［OR=0.25, 95% CI (0.13, 0.47)］, postoperative overall complications ［OR=0.34, 95% CI (0.26, 0.43)］, infection of incision ［OR=0.39, 95% CI (0.25, 0.62)］, intestinal obstruction ［OR=0.30, 95% CI (0.17, 0.53)］, lung infection ［OR=0.32, 95% CI (0.18, 0.57)］, and anastomotic fistula ［OR=0.40, 95% CI (0.22, 0.73)］ were decreased in the laparoscopic surgery as compared with the open surgery; the intraoperative lymph node resection ［WMD=–0.99, 95% CI (–2.11, 0.12)］, the rates of the 3-year disease-free survival ［OR=0.91, 95% CI (0.54, 1.54)］, pelvic infection ［OR=0.64, 95% CI (0.17, 2.45)］, anastomotic bleeding ［OR=0.54, 95% CI (0.22, 1.34)］, urinary retention ［OR=0.71, 95% CI (0.34, 1.48)］, and urinary tract infection ［OR=1.22, 95% CI (0.45, 3.30)］ had no significant differences between these two surgeries. Conclusion Laparoscopy surgery is still safer, more effective, and more reliable than conventional open surgery after neoadjuvant chemoradiotherapy in rectal cancer, but it needs more clinical RCTs to further provide accurate and reliable results.

Citation： HOU Songlin, LIU Daizhi, JIANG Xianhong, LIAO Hailing, YANG Song, CHEN Xiaobo, LI Lifa, ZHANG Guangjun, ZHOU Tong. Comparison of clinical efficacy of laparoscopy and open surgeries for rectal cancer after neoadjuvant chemoradiotherapy in China: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 578-591. doi: 10.7507/1007-9424.201711027 Copy

1.	Miyake Y, Nishimura J, Takahashi H, et al. The short-term outcomes of laparoscopic multivisceral resection for locally advanced colorectal cancer: our experience of 39 cases. Surg Today, 2017, 47(5): 575-580.
2.	Ju W, Luo X, Han B. Laparoscopic surgery is feasible for the treatment of rectal cancer after neoadjuvant chemoradiotherapy. Pak J Pharm Sci, 2016, 29(5 Suppl): 1817-1821.
3.	Panagiotopoulou IG, Parashar D, Qasem E, et al. Neoadjuvant long-course chemoradiotherapy for rectal cancer: Does time to surgery matter? Int Surg, 2015, 100(6): 968-973.
4.	郁寶銘, 林建江, 吳唯勤. 微粒化純化的黃酮成分治療痔急性發作的多中心自身對照臨床研究. 中華普通外科雜志, 2004, 19(12): 722-724.
5.	申麗君, 章真. 局部進展期直腸癌的放療規范及其進展. 中華胃腸外科雜志, 2016, 19(6): 618-620.
6.	Han Y, Xia Z, Guo S, et al. Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis. PLoS One, 2017, 12(1): e0170421.
7.	張國英, 池畔. 中低位直腸癌新輔助放化療后行腹腔鏡與開腹根治術圍手術期并發癥發生率的比較. 福州: 福建醫科大學, 2011.
8.	李彥良, 宋希林, 孫現軍, 等. 腹腔鏡與傳統手術聯合新輔助放化療治療中低位直腸癌短期療效對比. 中華普通外科雜志, 2012, 27(1): 68-69.
9.	劉海軍, 劉清安, 陳新文, 等. 腹腔鏡和開腹手術聯合同步新輔助放化療治療進展期直腸癌的近期療效比較. 中國腫瘤外科雜志, 2013, 5(1): 37-39.
10.	陳金湖, 池畔, 黃穎. 中低位直腸癌新輔助放化療后行腹腔鏡與開腹根治術的療效比較. 福州: 福建醫科大學, 2013.
11.	Hu JJ, Liang JW, Wang Z, et al. Short-term outcomes of laparoscopically assisted surgery for rectal cancer following neoadjuvant chemoradiotherapy: a single-center experience. J Surg Res, 2014, 187(2): 438-444.
12.	張杰, 龐志剛. 中低位直腸癌患者新輔助放化療后行腹腔鏡切除與開腹手術療效比較. 鄭州: 鄭州大學, 2014.
13.	Wang YW, Huang LY, Song CL, et al. Laparoscopic vs open abdominoperineal resection in the multimodality management of low rectal cancers. World J Gastroenterol, 2015, 21(35): 10174-10183.
14.	楊凱, 胡燕, 侯遠發, 等. 腹腔鏡與傳統手術聯合新輔助放化療治療直腸癌的療效分析. 中國腫瘤臨床與康復, 2015, 22(6): 708-710.
15.	譚文鋒, 蔡文德, 鄧煒琳, 等. 中低位直腸癌行腹腔鏡術聯合新輔助放化療的療效觀察. 臨床醫學工程, 2015, 22(2): 164-165.
16.	李磊, 張栗, 邊興花, 等. 基于新輔助放化療探究腹腔鏡與傳統開放手術治療低位直腸癌對患者并發癥及遠期預后的影響. 臨床合理用藥雜志, 2015, 8(31): 130-131.
17.	顧小年, 呂強, 俞旻浩. 腹腔鏡根治術聯合新輔助放化療治療中低位直腸癌的近期療效評價. 外科理論與實踐, 2016, 21(2): 142-145.
18.	劉英強, 陳淅涓, 姬社青, 等. 腹腔鏡與傳統開放手術聯合新輔助放化療治療中低位局部進展期直腸癌的安全性及并發癥的比較. 中華實驗外科雜志, 2016, 33(10): 2395-2397.
19.	臧書源. 新輔助放化療后行腹腔鏡治療直腸癌的并發癥分析. 世界臨床醫學, 2016, 10(21): 83-86.
20.	白東林, 李沁. 新輔助放化療后經腹腔鏡手術對中低位直腸癌的影響研究. 中國醫學前沿雜志 (電子版), 2016, 8(12): 50-53.
21.	葛磊, 雷程, 何丹, 等. 中低位進展期直腸癌長程新輔助放化療后腹腔鏡手術療效分析. 中華醫學雜志, 2016, 96(34): 2709-2712.
22.	陳峰, 姚勝. 新輔助放化療后行腹腔鏡與開腹手術治療直腸癌的價值及對并發癥發生率的影響. 現代消化及介入診療, 2016, 21(2): 266-268.
23.	Ju W, Luo X, Han B. Laparoscopic surgery is feasible for the treatment of rectal cancer after neoadjuvant chemoradiotherapy. Pak J Pharm Sci, 2016, 29(5 Suppl): 1817-1821.
24.	Chen W, Li Q, Qiu P, et al. Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy. J Cancer Res Ther, 2016, 12(Supplement): C199-C204.
25.	許衛東, 高軍茂, 趙一虹, 等. 直腸癌新輔助放化療后行腹腔鏡與開腹手術治療的價值及對并發癥發生率的影響分析. 中華腫瘤防治雜志. DOI: 10.16073/j.cnki.cjcpt.20170705.019.
26.	何若冰. 腹腔鏡聯合術前新輔助放化療對低位直腸癌保肛術患者術后并發癥及臨床療效的影響. 當代醫學, 2017, 23(2): 92-93.
27.	鄭樹, 張蘇展, 黃彥欽. 結直腸癌研究 30 年回顧和現狀. 實用腫瘤雜志, 2016, 31(1): 2-5.
28.	劉海軍, 劉清安, 陳新文, 等. 腹腔鏡和開腹手術聯合同步新輔助放化療治療進展期直腸癌的近期療效比較. 中國腫瘤外科雜志, 2013, 5(1): 37-39.
29.	Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
30.	Kim MS, Lim JS, Hyung WJ, et al. Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer. World J Gastroenterol, 2015, 21(9): 2711-2718.
31.	Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
32.	Misumi K, Harada H, Tsubokawa N, et al. Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers. Gen Thorac Cardiovasc Surg, 2017, 65(7): 392-399.
33.	Ahmed S, Eng C. Role of Chemotherapy in the neoadjuvant/adjuvant setting for patients with rectal adenocarcinoma undergoing chemoradiotherapy and surgery or radiotherapy and surgery. Curr Oncol Rep, 2018, 20(1): 3.
34.	張士義, 李學波, 張玉娟, 等. 新輔助放化療在低位直腸癌保肛術中的作用. 醫學與哲學, 2013, 34(2): 40-41.
35.	Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol, 2010, 11(7): 637-645.

1. Miyake Y, Nishimura J, Takahashi H, et al. The short-term outcomes of laparoscopic multivisceral resection for locally advanced colorectal cancer: our experience of 39 cases. Surg Today, 2017, 47(5): 575-580.
2. Ju W, Luo X, Han B. Laparoscopic surgery is feasible for the treatment of rectal cancer after neoadjuvant chemoradiotherapy. Pak J Pharm Sci, 2016, 29(5 Suppl): 1817-1821.
3. Panagiotopoulou IG, Parashar D, Qasem E, et al. Neoadjuvant long-course chemoradiotherapy for rectal cancer: Does time to surgery matter? Int Surg, 2015, 100(6): 968-973.
4. 郁寶銘, 林建江, 吳唯勤. 微粒化純化的黃酮成分治療痔急性發作的多中心自身對照臨床研究. 中華普通外科雜志, 2004, 19(12): 722-724.
5. 申麗君, 章真. 局部進展期直腸癌的放療規范及其進展. 中華胃腸外科雜志, 2016, 19(6): 618-620.
6. Han Y, Xia Z, Guo S, et al. Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis. PLoS One, 2017, 12(1): e0170421.
7. 張國英, 池畔. 中低位直腸癌新輔助放化療后行腹腔鏡與開腹根治術圍手術期并發癥發生率的比較. 福州: 福建醫科大學, 2011.
8. 李彥良, 宋希林, 孫現軍, 等. 腹腔鏡與傳統手術聯合新輔助放化療治療中低位直腸癌短期療效對比. 中華普通外科雜志, 2012, 27(1): 68-69.
9. 劉海軍, 劉清安, 陳新文, 等. 腹腔鏡和開腹手術聯合同步新輔助放化療治療進展期直腸癌的近期療效比較. 中國腫瘤外科雜志, 2013, 5(1): 37-39.
10. 陳金湖, 池畔, 黃穎. 中低位直腸癌新輔助放化療后行腹腔鏡與開腹根治術的療效比較. 福州: 福建醫科大學, 2013.
11. Hu JJ, Liang JW, Wang Z, et al. Short-term outcomes of laparoscopically assisted surgery for rectal cancer following neoadjuvant chemoradiotherapy: a single-center experience. J Surg Res, 2014, 187(2): 438-444.
12. 張杰, 龐志剛. 中低位直腸癌患者新輔助放化療后行腹腔鏡切除與開腹手術療效比較. 鄭州: 鄭州大學, 2014.
13. Wang YW, Huang LY, Song CL, et al. Laparoscopic vs open abdominoperineal resection in the multimodality management of low rectal cancers. World J Gastroenterol, 2015, 21(35): 10174-10183.
14. 楊凱, 胡燕, 侯遠發, 等. 腹腔鏡與傳統手術聯合新輔助放化療治療直腸癌的療效分析. 中國腫瘤臨床與康復, 2015, 22(6): 708-710.
15. 譚文鋒, 蔡文德, 鄧煒琳, 等. 中低位直腸癌行腹腔鏡術聯合新輔助放化療的療效觀察. 臨床醫學工程, 2015, 22(2): 164-165.
16. 李磊, 張栗, 邊興花, 等. 基于新輔助放化療探究腹腔鏡與傳統開放手術治療低位直腸癌對患者并發癥及遠期預后的影響. 臨床合理用藥雜志, 2015, 8(31): 130-131.
17. 顧小年, 呂強, 俞旻浩. 腹腔鏡根治術聯合新輔助放化療治療中低位直腸癌的近期療效評價. 外科理論與實踐, 2016, 21(2): 142-145.
18. 劉英強, 陳淅涓, 姬社青, 等. 腹腔鏡與傳統開放手術聯合新輔助放化療治療中低位局部進展期直腸癌的安全性及并發癥的比較. 中華實驗外科雜志, 2016, 33(10): 2395-2397.
19. 臧書源. 新輔助放化療后行腹腔鏡治療直腸癌的并發癥分析. 世界臨床醫學, 2016, 10(21): 83-86.
20. 白東林, 李沁. 新輔助放化療后經腹腔鏡手術對中低位直腸癌的影響研究. 中國醫學前沿雜志 (電子版), 2016, 8(12): 50-53.
21. 葛磊, 雷程, 何丹, 等. 中低位進展期直腸癌長程新輔助放化療后腹腔鏡手術療效分析. 中華醫學雜志, 2016, 96(34): 2709-2712.
22. 陳峰, 姚勝. 新輔助放化療后行腹腔鏡與開腹手術治療直腸癌的價值及對并發癥發生率的影響. 現代消化及介入診療, 2016, 21(2): 266-268.
23. Ju W, Luo X, Han B. Laparoscopic surgery is feasible for the treatment of rectal cancer after neoadjuvant chemoradiotherapy. Pak J Pharm Sci, 2016, 29(5 Suppl): 1817-1821.
24. Chen W, Li Q, Qiu P, et al. Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy. J Cancer Res Ther, 2016, 12(Supplement): C199-C204.
25. 許衛東, 高軍茂, 趙一虹, 等. 直腸癌新輔助放化療后行腹腔鏡與開腹手術治療的價值及對并發癥發生率的影響分析. 中華腫瘤防治雜志. DOI: 10.16073/j.cnki.cjcpt.20170705.019.
26. 何若冰. 腹腔鏡聯合術前新輔助放化療對低位直腸癌保肛術患者術后并發癥及臨床療效的影響. 當代醫學, 2017, 23(2): 92-93.
27. 鄭樹, 張蘇展, 黃彥欽. 結直腸癌研究 30 年回顧和現狀. 實用腫瘤雜志, 2016, 31(1): 2-5.
28. 劉海軍, 劉清安, 陳新文, 等. 腹腔鏡和開腹手術聯合同步新輔助放化療治療進展期直腸癌的近期療效比較. 中國腫瘤外科雜志, 2013, 5(1): 37-39.
29. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
30. Kim MS, Lim JS, Hyung WJ, et al. Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer. World J Gastroenterol, 2015, 21(9): 2711-2718.
31. Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
32. Misumi K, Harada H, Tsubokawa N, et al. Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers. Gen Thorac Cardiovasc Surg, 2017, 65(7): 392-399.
33. Ahmed S, Eng C. Role of Chemotherapy in the neoadjuvant/adjuvant setting for patients with rectal adenocarcinoma undergoing chemoradiotherapy and surgery or radiotherapy and surgery. Curr Oncol Rep, 2018, 20(1): 3.
34. 張士義, 李學波, 張玉娟, 等. 新輔助放化療在低位直腸癌保肛術中的作用. 醫學與哲學, 2013, 34(2): 40-41.
35. Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol, 2010, 11(7): 637-645.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of clinical efficacy of laparoscopy and open surgeries for rectal cancer after neoadjuvant chemoradiotherapy in China: a meta-analysis

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