| Objective:Evaluation of the effectiveness and safety of laparoscopic intersphincteric resection(ISR)in low rectal cancer surgery by comparing intraoperative and postoperative conditions with conventional open ISR Method:Through searching PubMed,Medline,China National Knowledge Infrastructure(CNKI)and Wanfang database,we select all published sphincter preservation surgery literatures before January 2010 to April 2018 to compare laparoscopic intersphincteric resection and conventional open ISR for the surgery literature of Ultra-low rectal cancer anus preservation.The documents were filtered according to the strictly criteria of inclusion and exclusion,then assessing the the included documents' quality.Finally,BY using the soft of Review Manager 5.1 to systematically evaluate the data of included literature.Result:Including 13 articles,total 1407 patients for comparative study.there are 15 observational indicators' date analysed detailedly The literature analyses the data of 15 observational indicators.There were 784 cases in the LAP group and 623 cases in the OS group.The results of this study Meta analysis: Compared with the OS group,the blood loss in the LAP group decreased by an average of 75.14 ml.There were significantly statistical differences in blood loss between the two groups(WMD=-75.14,95%CI:-116.43,-33.86,P=0.0004).the postoperative farting time of the LAP group was 2.03 days earlier than the OS group.The meta-analysis showed that there was a statistically significant difference between two groups in the time of postoperative farting between(WMD=-2.03,95%CI:-2.56,-1.50,P<0.0001).Compared to the OS group,LAP group average length of stay decreased 3.71 d,Meta analysis showed statistically significant differences in postoperative hospital stay ofpatients(WMD=-3.71,95%CI:-4.07,-3.35,P<0.0001).LAP group average number of lymph node dissection group than OS 1.12,number of lymph node dissection was statistically significant difference between the two groups of patients(OR=1.12,95%CI: 0.43,1.80,P=0.001).LAP postoperative wound infection rate was significantly lower than OS group,there were significant differences between two groups of patients after infection incision(OR=0.21,95%CI: 0.09,0.48,P=0.0002).The postoperatively complications' incidence of LAP group was significantly less than the OS group's,statistically significant differences in the case of the two groups of patients after complications(OR=0.48,95%CI: 0.34,0.66,P<0.00001)? Compared with OS group,LAP group can reduce the occurrence of postoperative intestinal obstruction.there ara significantly statistical difference between the two groups in postoperative intestinal obstruction(OR=0.44,95%CI:0.21,0.94,P=0.03)Compared with OS group,LAP group can reduce the incidence of postoperative pulmonary infection.The difference was statistically significant(OR=0.33,95%CI: 0.15,0.73,P=0.007).There were no significant differences between the two groups in the observation of positive margins,postoperative anastomotic stenosis,postoperative anastomotic leakage,postoperative rectovaginal fistula,postoperative abdominal infection,and postoperative urinary retention.In addition,in the five-year recurrence rate,operation time,lymph node dissection amount and other indicators,due to the small sample size in the randomized controlled trial group,the results have a large bias factor,and the conclusion needs to be further confirmed.Conclusious:Laparoscopic ISR can effectively reduce the amount of intraoperative blood loss,promoting postoperative recovery of intestinal function,reducing hospital stay,reducing postoperative wound infection,postoperative ileus,pulmonary infection and other postoperative complications,and abdominal cavity Mirror ISR surgery can more completely clean the lymph nodes around the tumor and reduce the 5-year recurrence rate after surgery,but the results need more researches to further confirm. |
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