| Objective: Compared the clinical effecacy of laparoscopy and open in anal sphincter preserving surgery for for mid-low rectal cancer,so as to evaluating the feasibility,safety and efficacy of laparoscopy.Methods: Databases of Pubmed,Embase,Cochrane Library,Chinese National Knowledge Infrastructure and WanFan were searched to retrieve randomized controlled trials about comparision of laparoscopic surgery with open surgery for mid-low rectal cancer with anal sphincter preservation.The retrieval time span was from database inception to October20,2017.Literature screening and data extraction in strict accordance with the inclusion criteria and exclusion criteria.The qualities of all the included randomized controlled trials were assessed by using the Cochrane reviewer’s handbook.Meta-analysis was performed by the Review Manager 5.3 software.Results: 11 randomized controlled trials involving 1090 patients were finally included,in which 542 patients had undergone laparoscopic surgery,and 548 patients had undergone open surgery.Compared with open surgery group,the laparoscopic surgery group was lower in the intraoperative bleeding loss(MD=-58.7,95%CI:-76.94~-40.42,P<0.01),shorter gastrointestinal function recovery time(MD=-1.30,95%CI:-1.52~-1.07,P<0.01),shorter hospital stay(MD=-3.94,95%CI:-5.69~-2.20,P<0.01),less total complications(RR=0.51,95%CI:0.35~0.73,P<0.01),less intestinal obstructions(RR=0.39,95%CI:0.20~0.77,P<0.01),fewer wound infections(RR=0.27,95%CI:0.11~0.63,P<0.01).There was no statistically significant differences in operative time(MD=9.48,95%CI:-9.75~28.7,P=0.33),the number of removed lymph nodes(MD=-0.98,95%CI:-2.83~0.86,P=0.30),local recurrence rate(RR=0.59,95%CI:0.34~1.02,P=0.06),distant metastasis rate(RR=0.75,95%CI:0.35~1.62,P=0.46),1-year overall survival rate(RR=1.06,95%CI:0.94~1.19,P=0.37),5-year overall survival rate(RR=1.06,95%CI:0.83~1.36,P=0.64).Conclusions: Meta-analysis show laparoscopic surgery is safe and feasible for anal sphincter preservation of mid-low rectal cancer.It has advantages of less postoperative complications and short hospital durations.There are no significant differences between two groups in terms of the lymph node harvest number,local recurrence rate,distant metastasis rate,1-year overall survival rate and 5-year overall survival rate. |
