A Meta-analysis Of Selective Lateral Lymph Node Dissection In The Treatment Of Low Rectal Cancer

Objective: to compare the clinical effects of lateral lymph node dissection(LLND)and traditional total mesorectal excision(TME)in the treatment of low rectal cancer by meta analysis.Methods: A computer search was made of the literature on the efficacy of TME surgery plus lateral lymph node dissection in the treatment of low rectal cancer by PubMed,Embase,Cochrane Library,wanfang database,CNKI and Chinese biomedical literature database in the past decade,Remove the substandard and repetitive literature,screen the articles unrelated to the research one by one and extract the target data according to the inclusion criteria and exclusion criteria.The literature quality of the included literature was evaluated by using the Newcastle Ottawa quality Assessment scale(NOS)and the Cochrane Bias Risk Assessment Form.Meta analysis of target data using RevMan5.3 software.According to the heterogeneity,the fixed effect model or random effect model is used to combine the effects quantities of the relative Odds ratio or weighted mean difference and 95% confidence interval,and the relevant conclusions are drawn after comprehensive analysis.Results: A total of 16 articles include 13 in English and 3 in Chinese were obtained for meta analysis.A total of 6591 patients were enrolled in the study,including 2772 in LLND group and 3819 in TME group.By comparing the clinical effects of LLND group and TME group in the treatment of low rectal cancer,it can be concluded that: there was no significant difference in 5-year survival rate(OR=1.05,95%CI:0.81-1.38,P=0.70),recurrence rate of distant metastasis(OR=0.89,95%CI:0.49-1.62,P=0.71),and 3-year recurrence-free survival rate(OR=1.16,95%CI:0.93-1.44,P=0.18)between the two groups;The local recurrence rate was statistically different between the two groups(OR=0.70,95%CI: 0.55-0.88,P=0.002);The incidence of perioperative complications(OR=1.37,95%CI:1.05-1.80,P=0.02)and urinary dysfunction(OR=2.15,95%CI:1.29-3.58,P=0.003)in LLND group was higher than that in TME group;The operation time was significantly longer(WMD =99.84 min,95%CI:66.54-133.15,p<0.0001)and the blood loss was significantly increased(WMD=194.51 ml,95%CI:124.17-264.84,p<0.0001)in the LLND group.Conclusion: Lateral lymph node dissection did not improve the prognosis of low rectal cancer.Compared with traditional radical surgery,lateral lymph node dissection can reduce the local recurrence rate in patients with low rectal cancer.The complications of lateral lymph node dissection were higher than those of the traditional radical surgery group...