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[目的]评价腹腔镜与开腹直肠癌手术术后复发率的长期肿瘤学效果。[方法]系统检索Medline、Embase、Cochrane中1991年1月至2012年10月间发表的有关腹腔镜与开腹直肠癌手术后复发率比较的随机对照研究(RCT)。由2名评价员独立筛选并提取数据资料,对符合纳入标准的研究使用RevMan5.1软件进行统计分析。[结果]共纳入12个临床随机对照研究,病例总数2259例,其中LRR组1158例,ORR组1101例。腹腔镜直肠癌切除术对比开腹手术治疗直肠癌的术后总体复发率(OR=0.92,95%CI:0.66～1.28,P=0.61)、局部复发率(OR=0.79,95%CI:0.49～1.28,P=0.34)、远处转移率(OR=0.87,95%CI:0.59～1.27,P=0.47)及术后戳孔或切口种植转移率(OR=1.34,95%CI:0.07～24.10,P=0.84)差异均无统计学意义。[结论]腹腔镜直肠切除术对比传统开腹手术治疗直肠癌其术后长期肿瘤学效果相当,并不会导致术后各类复发率明显升高。但其长期生存效果需要更多大样本、高质量的前瞻性多中心的临床随机对照试验来证实。
[Objective] To evaluate the long-term oncology effect of laparoscopic and open rectal cancer surgery recurrence rate. [Methods] A systematic randomized controlled trial (RCT) comparing the recurrence rate after laparoscopic and open rectal cancer surgery between January 1991 to October 2012 in Medline, Embase and Cochrane was systematically searched. Two reviewers independently screened and extracted the data, and used the RevMan5.1 software for statistical analysis of the eligible studies. [Results] A total of 12 clinical randomized controlled trials were included, with a total of 2259 cases, including 1158 in the LRR group and 1101 in the ORR group. Laparoscopic resection of laparoscopic resection of rectal cancer compared with the overall recurrence rate (OR = 0.92,95% CI: 0.66 to 1.28, P = 0.61), the local recurrence rate (OR = 0.79,95% CI: 0.49 ~ 1.28, P = 0.34), distant metastasis rate (OR = 0.87, 95% CI: 0.59-1.27, P = 0.47) 24.10, P = 0.84) showed no significant difference. [Conclusion] The long-term oncology effect of laparoscopic rectal resection compared with traditional laparotomy in rectal cancer does not lead to significantly higher recurrence rate after operation. But its long-term survival needs more large samples, and high-quality, prospective, multicenter randomized controlled trials.