| Objective: With the application of a series of treatment methods such as surgery,radiotherapy,and chemotherapy,the short-and long-term efficacy of rectal cancer has been greatly improved.Transanal endoscopic microsurgery(TEM)reduces surgical trauma and related complications in the treatment of benign and malignant lesions,and its rapid postoperative recovery characteristics have attracted widespread attention,but its effectiveness in the treatment of rectal cancer Security is still controversial.This article systematically analyzes the clinical efficacy of TEM versus laparoscopic surgery(LS)in the treatment of stage I rectal cancer,and provides a reference for the choice of rectal cancer treatment.Methods: Search Pub Med,the Cochrane Library,Embase,Wan fang Database,CNKI and other publicly published multi-center clinical studies of transanal endoscopic microsurgery versus laparoscopic surgery for the treatment of stage I rectal cancer before December 2020,and screen relevant literature,The data was extracted,and the data was processed using Rev Man5.3 software.Results: A total of 16 clinical trials were included in this article,including4 in English and 12 in Chinese.A total of 1229 patients were enrolled,including579 patients undergoing transanal endoscopic minimally invasive surgery and650 patients undergoing laparoscopic surgery.1.Operation time:(MD=-74.34,95%CI=-85.89～-62.79,P<0.00001),the TEM group is shorter than the LS group,the difference is statistically significant(P<0.05).Intraoperative blood loss:(MD=-83.62,95%CI=-97.86～-69.39,P<0.00001)The TEM group was less than the LS group,and the difference was statistically significant(P<0.05).The number of lymph node dissection:(MD=-4.90,95%CI=-14.90 ～ 5.09,P=0.34).The number of lymph node dissection in the TEM group was less than that in the LS group,but the difference was not statistically significant(P>0.05).2.Time of first exhaust after operation:(MD=-32.13,95%CI=-36.96～-27.30,P<0.00001)TEM group was earlier than LS group,the difference was statistically significant(P < 0.05).Total hospital stay:(MD=-6.17,95%CI=-7.86～-4.49,P<0.00001)The TEM group was shorter than the LS group,and the difference was statistically significant(P<0.05).Postoperative hospital stay:(MD=-3.21,95%CI=-3.35～-3.06,P<0.00001)The TEM group was shorter than the LS group,and the difference was statistically significant(P<0.05).3.Postoperative complications:(OR=0.30,95%CI=0.20 ～ 0.44,P <0.00001)TEM group was less than LS group,the difference was statistically significant(P<0.05).Postoperative bleeding:(OR=0.45,95%CI=0.16～1.26,P=0.13)The TEM group was less than the LS group,and the difference was not statistically significant(P>0.05).Anastomotic leakage:(OR=0.45,95%CI=0.22～0.94,P=0.03)The incidence of TEM group was lower than that of LS group,and the difference was statistically significant(P<0.05).Incision infection:(OR=0.35,95%CI=0.11～1.08,P=0.07)The incidence of TEM group was lower than that of LS group,but the difference was not statistically significant(P>0.05).Urinary retention:(OR=0.64,95%CI=0.22～1.86,P=0.41)The incidence of TEM group was smaller than that of LS group,and the difference was not statistically significant(P>0.05).Anal incontinence:(OR=0.40,95%CI=0.14～1.12,P=0.08)The incidence of TEM group was lower than that of LS group,but the difference was not statistically significant(P>0.05).Analgesic application:(OR=0.00,95%CI=0.00～0.01,P<0.00001),the TEM group was less than the LS group,the difference was statistically significant(P<0.05).Sexual dysfunction:(OR=0.16,95%CI=0.04～0.71,P=0.02),the TEM group was less than the LS group,the difference was statistically significant(P<0.05).4.Postoperative recurrence and metastasis:(OR=0.77,95%CI=0.29～2.09,P=0.61)There was no significant difference in the recurrence and metastasis rate of T1 rectal cancer after TEM compared with the LS group(P>0.05).After neoadjuvant chemotherapy,the recurrence and metastasis rate of T2 rectal cancer after TEM was not significantly different than that in the LS group.Conclusions:(1)Compared with LS,TEM has greater advantages in perioperative outcomes such as operation time,intraoperative blood loss,first postoperative air displacement,hospitalization time,postoperative hospitalization time,and analgesic application.The perioperative treatment effect of rectal cancer better.(2)TEM has a lower incidence of surgical complications than LS,and TEM can reduce surgery-related complications.(3)TEM can partially replace LS in the application of stage I rectal cancer. |
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