Laparoscopic Intersphincteric Resection Versus Open Intersphincteric Resection In Sphincter-preserving Surgery Of Ultralow Rectal Carcinom: A Meta-analysis

Objective:To evaluation the clinical safety and efficacy of laparoscopic intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom.Methods:Studies comparing laparoscopic intersphincteric resection with open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinoma were identified from Pub Med,Medline,Ovid,China National Knowledge Infrastructure(CNKI)and Wanfang databases by 2016.With strictly screening accordance to the standard,assessing the quality of these studies,data were extracted from these trials and analyzed by the Review Manager 5.3 software.Results:Ten observational studies with a total of 939 patients(501 laparoscopic surgery groups and 438 open surgery groups)were identified.Meta analysis showed that:comparing with open surgery group,laparoscopic surgical operation time extended by an average of 36.28min(WMD=36.28,95%CI:4.30~68.26,P<0.05),average reduced intraoperative bleeding 95.84 m L(WMD=-95.84,95%CI:-123.64~-68.03,P<0.01),time of bowel function returning(WMD=-1.05,95%CI:-1.70~-0.41,P<0.01),dieting(WMD=-0.95,95%CI:-1.34~-0.55,P<0.01)and hospital staying after operation(WMD=-2.43,95%CI:-3.95~-0.92,P<0.01)reduced by an average of 1.05 d,0.95 d,2.43 d,respectively;Incidence of overall complications(OR=0.60,95%CI:0.44~0.84,P<0.01),positiving circumferential resection margin(OR=2.49,95%CI:1.12~5.54,P<0.05),and wound infection(OR=0.20,95%CI:0.07~0.60,P<0.01)reduced respectively;No statistically significant differences were found with the local recurrence rate,distant metastasis,anastomotic leakage,postoperative intestinal obstruction between the two groups(P>0.05);While the two groups needed further research in terms of number of lymph node dissection in the surgery.Conclusious:Meta analysis show that laparoscopic intersphincteric resection is completely safe and effective for ultralow rectal cancer surgery patients,in accordance with concept of the embryonic anatomy,oncological surgery and delicate,is expected to become a standardization operation method for ultralow rectal carcinoma.