The short-term efficacy of laparoscopic transanal pull through surgery <i>versus</i> conventional laparoscopic surgery for rectal cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHEN Xiaobo ¹ , FENG Yan ²

1. Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;
2. Department of Anesthesiology, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

CHEN Xiaobo, Email: cxb64457@163.com

Keywords：

rectal cancer; laparoscopic transanal pull through surgery; conventional laparoscopic surgery; short-term efficacy; meta-analysis

DOI：

10.7507/1007-9424.201907088

Video：

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Objective To compare the short-term efficacy of laparoscopic transanal pull through surgery and conventional laparoscopic surgery for rectal cancer.Methods Relevant literatures were retrieved from databases including PubMed, Cochrane Library databases, Embase, CNKI, CBM, Wan-fang database, and VIP databases from Jan. 2009 to Jul. 2019, all the relevant trial documents ［included randomized controlled trial and non randomized controlled trial］ were collected for comparison of laparoscopic transanal pull through surgery and conventional laparoscopic surgery on the clinical efficacy of rectal cancer patients, the qualified literatures were screened in strict accordance with inclusion and exclusion criteria, and Stata12.0 software was used for statistical analysis.Results A total of 19 articles were included in the literature with 2 683 patients were included among them. Meta analysis results showed that, compared with the conventional laparoscopic surgery group, in laparoscopic transanal pull through surgery group, operation time [WMD=–6.78, 95% CI was (–11.96, –1.60), P<0.01], intraoperative blood loss [WMD=–14.94, 95% CI was (–23.48, –6.40),P<0.01], postoperative exhaust time [WMD=–13.55, 95% CI was (–18.24, –8.85), P<0.01], postoperative hospitalization time [WMD=–1.60, 95% CI was (–2.00, –1.21), P<0.01], incidence of postoperative overall complication [OR=0.50, 95% CI was (0.38, 0.67), P<0.01], and incidence of incision infection [OR=0.19, 95% CI was (0.08, 0.45), P<0.01] reduced. Those differences were not significant, such as intraoperative lymph node resection [WMD=–0.02, 95% CI was (–0.44, 0.40), P=0.92], incision margin distance of tumor [WMD=0.13, 95% CI was (–0.30, 0.55), P=0.56], and incidence of anastomotic fistula [OR=0.97, 95% CI was (0.62, 1.50), P=0.87].Conclusions Laparoscopic transanal pull through surgery has more safe, effective, and reliable effects than conventional laparoscopic surgery for rectal cancer. It has further research value, but there may be inevitable bias and other effects in the included literatures, so more randomized controlled clinical trials are needed in the future.

Citation： CHEN Xiaobo, FENG Yan. The short-term efficacy of laparoscopic transanal pull through surgery versus conventional laparoscopic surgery for rectal cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(4): 464-475. doi: 10.7507/1007-9424.201907088 Copy

1.	Karachun AM, Petrova EA, Pelipas YV, et al. Laparoscopic surgery for rectal cancer: a literature review and own experience. Vopr Onkol, 2015, 61(6): 861-866.
2.	Parker JM, Feldmann TF, Cologne KG. Advances in laparoscopic colorectal surgery. Surg Clin North Am, 2017, 97(3): 547-560.
3.	周海濤, 周志祥, 梁建偉, 等. 無切口腹腔鏡下直腸外翻技術的直腸癌低位前切除術的近期療效. 中華腫瘤雜志, 2015, 37(1): 63-66.
4.	Shimizu H, Adachi K, Ohtsuka H, et al. Totally laparoscopic resection for low sigmoid and rectal cancer using natural orifice specimen extraction techniques. Surg Laparosc Endosc Percutan Tech, 2017, 27(4): e74-e79.
5.	李琦, 洪潮, 沈黎輝, 等. 運用 Cochrane 評價系統的方法評價針灸療法治療神經根型頸椎病的療效. 實用臨床醫藥雜志, 2015, 19(z1): 82-83.
6.	許凌, 尤慶生, 林雷, 等. 主動脈弓部夾層動脈瘤治療方法的 Meta 分析. 老年醫學與保健, 2018, 24(4): 454-460.
7.	黃順榮, 馮澤榮, 秦千子, 等. 完全腹腔鏡與腹腔鏡輔助直腸癌保肛手術近期療效比較的研究. 廣西醫科大學學報, 2009, 26(1): 113-115.
8.	陳開運, 向國安, 王漢寧, 等. 免輔助切口腹腔鏡手術治療低位直腸癌. 中華普通外科雜志, 2010, 25(2): 137-140.
9.	王德舉, 周志明, 孟憲春, 等. 腹腔鏡輔助下直腸外翻拖出式手術在中低位直腸癌治療中的無瘤技術與臨床價值. 河北醫科大學學報, 2012, 33(1): 39-41.
10.	姚寒暉, 黃強, 寧忠良, 等. 經肛拖出式全腹腔鏡直腸前切除同腹腔鏡輔助直腸前切除對比研究. 安徽醫科大學學報, 2014, 49(5): 676-678.
11.	Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol, 2014, 20(44): 16707-16713.
12.	汪春良, 袁航, 許映, 等. 腹腔鏡中低位直腸癌經肛拖出切除 92 例療效觀察. 中華胃腸外科雜志, 2014, 17(8): 836-838.
13.	Zhang X, Zhou H, Liang J, et al. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis, 2014, 29(9): 1119-1124.
14.	余思, 鄧建中, 計勇, 等. 改良式經肛門取標本技術在腹腔鏡直腸前切除術治療低位乙狀結腸或高位直腸癌中的應用. 中華普通外科學文獻: 電子版, 2016, 10(4): 264-267, 290.
15.	張永康, 張劍, 廖曉鋒. 腹腔鏡下直腸經肛門拖出式手術與直腸前切除術治療低位直腸癌的比較. 中國微創外科雜志, 2016, 16(8): 736-739.
16.	林恒軍, 邱學科, 袁航. 經肛拖出式全腹腔鏡直腸癌前切除在直腸癌患者中的臨床價值. 中國內鏡雜志, 2017, 23(1): 1-5.
17.	趙澤峰, 楊之斌. 經肛門拖出式全腔鏡直腸前切除術治療中低位直腸癌效果觀察. 山東醫藥, 2017, 57(34): 53-55.
18.	黃亮, 余壯明, 李軍, 等. 腹部無切口腹腔鏡低位直腸癌前切除經肛門取出標本的臨床分析. 中華普外科手術學雜志: 電子版, 2017, 11(3): 237-239.
19.	蘇松盛, 何進達, 曾凡英. 腹腔鏡下無腹部切口直腸癌切除經肛門外翻拖出吻合臨床分析. 中華普外科手術學雜志: 電子版, 2017, 11(3): 233-236.
20.	張鈞. 腹部無輔助切口腹腔鏡直腸癌根治術的效果分析. 中華普外科手術學雜志: 電子版, 2017, 11(4): 298-301.
21.	梁平. 腹腔鏡下直腸低位前切除術與直腸經肛門拖出切除術治療直腸癌的效果比較. 中華普外科手術學雜志: 電子版, 2018, 12(1): 46-48.
22.	Park JS, Kang H, Park SY, et al. Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study. Ann Surg Treat Res, 2018, 94(1): 26-35.
23.	Liu Z, Efetov S, Guan X, et al. A multicenter study evaluating natural orifice specimen extraction surgery for rectal cancer. J Surg Res, 2019, 243: 236-241.
24.	Hu JH, Li XW, Wang CY, et al. Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer. World J Clin Cases, 2019, 7(2): 122-129.
25.	李瑞生, 胡濱, 張富, 等. 改良無輔助切口完全腹腔鏡全直腸系膜切除術治療直腸癌的療效. 中國微創外科雜志, 2019, 19(1): 46-49.
26.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
27.	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.
28.	Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol, 2014, 20(36): 12981-12992.
29.	D’Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis, 2011, 13(Suppl 7): 28-31.
30.	Zhang H, Cong JC, Ling YZ, et al. Laparoscopic low anterior resection of the rectum with transanal prolapsing specimen extraction: early experience with 23 patients. J Laparoendosc Adv Surg Tech A, 2016, 26(5): 379-385.
31.	成昌霞, 周學穎, 李福瑋, 等. 手術時間對手術切口感染影響的研究. 中華醫院感染學雜志, 2016, 26(5): 1111-1112, 1123.
32.	楊玉波, 關鐵軍, 王斌, 等. 直腸癌手術切口感染的危險因素分析與預防對策. 中華醫院感染學雜志, 2015, 25(1): 184-186.

1. Karachun AM, Petrova EA, Pelipas YV, et al. Laparoscopic surgery for rectal cancer: a literature review and own experience. Vopr Onkol, 2015, 61(6): 861-866.
2. Parker JM, Feldmann TF, Cologne KG. Advances in laparoscopic colorectal surgery. Surg Clin North Am, 2017, 97(3): 547-560.
3. 周海濤, 周志祥, 梁建偉, 等. 無切口腹腔鏡下直腸外翻技術的直腸癌低位前切除術的近期療效. 中華腫瘤雜志, 2015, 37(1): 63-66.
4. Shimizu H, Adachi K, Ohtsuka H, et al. Totally laparoscopic resection for low sigmoid and rectal cancer using natural orifice specimen extraction techniques. Surg Laparosc Endosc Percutan Tech, 2017, 27(4): e74-e79.
5. 李琦, 洪潮, 沈黎輝, 等. 運用 Cochrane 評價系統的方法評價針灸療法治療神經根型頸椎病的療效. 實用臨床醫藥雜志, 2015, 19(z1): 82-83.
6. 許凌, 尤慶生, 林雷, 等. 主動脈弓部夾層動脈瘤治療方法的 Meta 分析. 老年醫學與保健, 2018, 24(4): 454-460.
7. 黃順榮, 馮澤榮, 秦千子, 等. 完全腹腔鏡與腹腔鏡輔助直腸癌保肛手術近期療效比較的研究. 廣西醫科大學學報, 2009, 26(1): 113-115.
8. 陳開運, 向國安, 王漢寧, 等. 免輔助切口腹腔鏡手術治療低位直腸癌. 中華普通外科雜志, 2010, 25(2): 137-140.
9. 王德舉, 周志明, 孟憲春, 等. 腹腔鏡輔助下直腸外翻拖出式手術在中低位直腸癌治療中的無瘤技術與臨床價值. 河北醫科大學學報, 2012, 33(1): 39-41.
10. 姚寒暉, 黃強, 寧忠良, 等. 經肛拖出式全腹腔鏡直腸前切除同腹腔鏡輔助直腸前切除對比研究. 安徽醫科大學學報, 2014, 49(5): 676-678.
11. Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol, 2014, 20(44): 16707-16713.
12. 汪春良, 袁航, 許映, 等. 腹腔鏡中低位直腸癌經肛拖出切除 92 例療效觀察. 中華胃腸外科雜志, 2014, 17(8): 836-838.
13. Zhang X, Zhou H, Liang J, et al. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis, 2014, 29(9): 1119-1124.
14. 余思, 鄧建中, 計勇, 等. 改良式經肛門取標本技術在腹腔鏡直腸前切除術治療低位乙狀結腸或高位直腸癌中的應用. 中華普通外科學文獻: 電子版, 2016, 10(4): 264-267, 290.
15. 張永康, 張劍, 廖曉鋒. 腹腔鏡下直腸經肛門拖出式手術與直腸前切除術治療低位直腸癌的比較. 中國微創外科雜志, 2016, 16(8): 736-739.
16. 林恒軍, 邱學科, 袁航. 經肛拖出式全腹腔鏡直腸癌前切除在直腸癌患者中的臨床價值. 中國內鏡雜志, 2017, 23(1): 1-5.
17. 趙澤峰, 楊之斌. 經肛門拖出式全腔鏡直腸前切除術治療中低位直腸癌效果觀察. 山東醫藥, 2017, 57(34): 53-55.
18. 黃亮, 余壯明, 李軍, 等. 腹部無切口腹腔鏡低位直腸癌前切除經肛門取出標本的臨床分析. 中華普外科手術學雜志: 電子版, 2017, 11(3): 237-239.
19. 蘇松盛, 何進達, 曾凡英. 腹腔鏡下無腹部切口直腸癌切除經肛門外翻拖出吻合臨床分析. 中華普外科手術學雜志: 電子版, 2017, 11(3): 233-236.
20. 張鈞. 腹部無輔助切口腹腔鏡直腸癌根治術的效果分析. 中華普外科手術學雜志: 電子版, 2017, 11(4): 298-301.
21. 梁平. 腹腔鏡下直腸低位前切除術與直腸經肛門拖出切除術治療直腸癌的效果比較. 中華普外科手術學雜志: 電子版, 2018, 12(1): 46-48.
22. Park JS, Kang H, Park SY, et al. Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study. Ann Surg Treat Res, 2018, 94(1): 26-35.
23. Liu Z, Efetov S, Guan X, et al. A multicenter study evaluating natural orifice specimen extraction surgery for rectal cancer. J Surg Res, 2019, 243: 236-241.
24. Hu JH, Li XW, Wang CY, et al. Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer. World J Clin Cases, 2019, 7(2): 122-129.
25. 李瑞生, 胡濱, 張富, 等. 改良無輔助切口完全腹腔鏡全直腸系膜切除術治療直腸癌的療效. 中國微創外科雜志, 2019, 19(1): 46-49.
26. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
27. 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.
28. Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol, 2014, 20(36): 12981-12992.
29. D’Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis, 2011, 13(Suppl 7): 28-31.
30. Zhang H, Cong JC, Ling YZ, et al. Laparoscopic low anterior resection of the rectum with transanal prolapsing specimen extraction: early experience with 23 patients. J Laparoendosc Adv Surg Tech A, 2016, 26(5): 379-385.
31. 成昌霞, 周學穎, 李福瑋, 等. 手術時間對手術切口感染影響的研究. 中華醫院感染學雜志, 2016, 26(5): 1111-1112, 1123.
32. 楊玉波, 關鐵軍, 王斌, 等. 直腸癌手術切口感染的危險因素分析與預防對策. 中華醫院感染學雜志, 2015, 25(1): 184-186.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The short-term efficacy of laparoscopic transanal pull through surgery versus conventional laparoscopic surgery for rectal cancer: a meta-analysis

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