Comparison Of Short-term Surgical Treatment Of Rectal Cancer With Laparoscopic Total Mesorectal Excision And Simple Laparoscopic Surgery:A Meta-analysis

Objective:A meta-analysis was conducted to investigate the short-term efficacy of trans-abdominal anorectal total mesorectal excision(LA-taTME)and simple laparoscopic surgery(LTME)in the treatment of rectal cancer.Methods:Find and develop English and Chinese keywords related to LA-taTME and LTME operations and free words,and search English databases:Pebmed,Embase,and Cochrane library databases;Chinese databases:All relevant research topics in China Knowledgebase and Wanfang Database The relevant content,time is set to begin in December 2017 until the database is built.Formulate inclusion and exclusion criteria,conduct primary screening and secondary screening based on the inclusion and exclusion criteria,and finally obtain a document that meets the requirements after detailed full-text screening.According to the12 indicators in the MINORS quality evaluation standard,the inclusion of the literature is performed.Quality Evaluation.The data extraction was conducted and completed independently by two researchers.If necessary,the third researcher could be invited to discuss and solve the problem to ensure the authenticity of the extracted data to the greatest extent possible.The statistical processing of the extracted data was analyzed using RevMan 5.3 software.The odds ratio(OR)and the mean difference(MD)were used as the statistics for the binary and continuous variables,respectively,and the corresponding 95%was calculated using the analysis software.The letter interval(CI).Heterogeneity of the adopted literature that meets the inclusion criteria was analyzed using the Q test and the I~2test.If the P value in the Q test is?0.1 or I~2?50%in the I~2 test,the heterogeneity of the study is not high,and The FEM was used to process statistics;if the P-value in the Q-test was<0.1 or I~2>50%in the I~2 test,the heterogeneity of the study was high and the REM-pooled statistics were used.P<0.05 indicated statistically significant differences between the LA-taTME and LTME groups.Results:After detailed screening,the final documents included:6 English articles and 2Chinese articles.All the literatures concerning LA-taTME and LTME surgery included were high-quality literature.Six of them involved duration of surgery,six cases involving total length of hospital stay,four cases involving intraoperative blood loss,six cases involving lymph node dissection,five cases involving surgical conversion to laparotomy,and seven cases involving peripheral circumferential margin positive rates.The 6 articles involved the incomplete mesorectal rate,5 cases involving intraoperative complications and the incidence of postoperative short-term complications.Results of statistical software analysis showed that the heterogeneity between the groups during the operation duration was significant(P<0.00001,I~2=87%),and there was no significant difference in the operation time between the LA-taTME and LTME groups(P=0.09);The heterogeneity between groups was significant at time(P=0.0007,I~2=77%),and the difference in total length of stay between the LA-taTME and LTME groups was statistically significant(P=0.008);The heterogeneity was significant(P=0.007,I~2=75%).There was a statistically significant difference in intraoperative blood loss between the LA-taTME and LTME groups(P=0.01);the heterogeneity between the groups in the number of lymph node dissections was not significant.Significantly(P=0.83,I~2=0%),there was no significant difference in the number of clearing lymph nodes between the LA-taTME and LTME groups(P=0.90);the heterogeneity between groups was not significant during the conversion to laparotomy(P=0.33,I~2=12%),there was a statistically significant difference in laparotomy rates between LA-taTME and LTME groups(P=0.002);heterogeneity was not significant between the groups in the rate of positive peripheral resection margins(P=0.91,I~2=0%),there was a statistically significant difference in the positive rate of the circumferential margin between the two groups(P=0.02);the rectum system There was no significant heterogeneity among the groups in the incompleteness rate(P=0.33,I~2=13%).The difference in incompleteness of mesenteric specimens between the two groups was statistically significant(P=0.02);There was no significant heterogeneity among the groups in the incidence of complications and short-term complications after surgery(P=0.10,I~2=49%).There were significant differences in intraoperative and postoperative complications between the two groups(P<0.0001).Conclusion:(1)LA-taTME group compared with LTME group in the total length of hospital stay,intraoperative blood loss,conversion to open surgery,peripheral resection margin positive rate,mesorectal incomplete rate,intraoperative complications and postoperative short-term complications The rate of surgical treatment has advantages.(2)There was no obvious advantage in LA-taTME group compared with LTME group in the duration of operation and lymph node dissection.