The Safety And Efficacy Of Laparoscopic Surgery And Open Surgery In Treatment Of Mid-low Rectal Cancer After Neoadjuvant Chemoradiotherapy: A Meta-analysis

Objective:To evaluate the safety and efficacy of laparoscopic surgery and open surgery in treatment of mid-low rectal cancer after neoadjuvant chemoradiotherapy.Methods:Chinese and English databases were searched for Chinese and English literature on this study,included from January 2010 to October 2020,and after screening the literature and quality evaluation,meta-analysis was performed using Rev Man 5.4 software.Results:A total of 8 publications with a total of 1017 patients were included,including 496 patients in the laparoscopic surgery group and 521 in the open surgery group.Meta-analysis results suggested that the laparoscopic group had significantly less intraoperative bleeding(WMD =-74.78,95%Cl=-101.12～-48.44,P<0.00001)and a higher rate of the sphinctersaving(OR= 2.01,95% Cl= 1.33-3.03,P= 0.001),time to first postoperative venting(WMD=-0.76,95% Cl=-1.01～-0.52,P<0.00001),time to first postoperative feeding(WMD=-0.70,95%Cl =-0.91～-0.49,P< 0.00001),and postoperative hospital stay(WMD =-2.71,95% Cl =-4.54～-0.88,P= 0.004)were shorter than those in the open group,and had a lower postoperative complications rate(OR=0.59,95% Cl=0.43～0.82,P= 0.001).The differences in operative time and number of intraoperative lymph nodes removed between the two groups were not statistically significant.In the long-term efficacy,the 3-year disease-free survival rate was higher in the Laparoscopic group(OR=1.54,95% Cl =1.07～2.23,,P=0.02).There was no significant difference in 3-year overall survival rate between the two surgeries(OR=1.23,95% Cl=0.77～1.97,P= 0.38).Conclusion:Laparoscopic surgery is a technically safe and feasible surgical procedure with good clinical efficacy for mid-low rectal cancer patients after neoadjuvant chemoradiotherapy compared with open surgery.