Meta Analysis Of Clinical Efficacy Of Preoperative Neoadjuvant Chemoradiotherapy Combined With TME In The Treatment Of Middle And Low Rectal Cancer

Objective:To explore the application value of preoperative neoadjuvant chemoradiotherapy combined with TME in middle and low rectal cancer.Methods:The literatures of clinical control studies on preoperative neoadjuvant chemoradiotherapy combined with TME in the treatment of middle and low rectal cancer between January 2010 and October 2018 in Chinese and English databases were searched and collected.The experimental group was preoperative neoadjuvant chemoradiotherapy combined with total mesorectal resection(NCRT+TME),and the control group was simple total mesorectal resection(TME).Literature that met the inclusion criteria were selected for quality evaluation,relevant data were extracted,and Meta analysis was performed using RevMan5.3 software.Analysis indexes included:operation time,intraoperative blood loss,overall postoperative complication rate,postoperative anastomotic fistula rate,postoperative incision infection rate,postoperative local recurrence rate.Results:A total of 15 articles were included,with a total of 3866 patients.Preoperative neoadjuvant chemoradiotherapy combined with total mesorectal resection(NCRT+TME)was performed in 1571 patients,and total mesorectal resection alone(TME)in 2295 patients.The analysis results are as follows:(1)operation time:there was no significant difference between the two groups(WMD:-1.25;95%CI:-2.69～0.19;P=0.09>0.05).(2)intraoperative blood loss:there was no significant difference between the two groups(WMD=-0.04,95%CI:-23.56-23.49,P=1.00>0.05).(3)overall postoperative complication rate:there was no significant difference between the two groups(OR:1.19,95%CI:0.80～1.77,P=0.38>0.05).(4)postoperative incidence of anastomotic fistula:there was no significant difference between the two groups(OR:0.95,95%CI:0.73～1.23,P=0.67>0.05).(5)postoperative incisional infection rate:there was no significant difference between the two groups(OR:1.17,95%CI:0.64～2.14,P=0.60>0.05).(6)postoperative local recurrence rate:NCRT+TME group was significantly reduced,and the difference was statistically significant(OR:0.44,95%CI:0.24～0.78,P=0.005<0.05).Conclusion:Meta analysis results show that for low rectal cancer in patients,compared with the simple line of total mesorectum excision,preoperative neoadjuvant chemoradiotherapy combined total mesorectum excision can significantly reduce rectal cancer local recurrence rate,intraoperative blood loss and operation time there was no significant difference,and does not increase the postoperative anastomotic fistula,infection of incision,incidence of postoperative complications.In addition,due to the limited sample size of patients included in this study and the existence of bias,our results still need to be demonstrated by more samples and more rigorous clinical studies.