| Objective:Patients with the Traditional laparoscopic abdomino-perineal resection(APR)must do Colon colostomy.It brings many troubles for patients,also brings bid challenges to the gastrointestinal surgery.The laparoscopic total mesenteric resection(TME)combined with transanal intersphincteric resection(ISR)can save patient’ anus in the greatest degree,and maintain the original physiological structure of the digestive tract.the purpose of this article is to investigate the safety and feasibility of the laparoscopic total mesenteric resection(TME)combined with intersphincteric resection(ISR)for ultra-low rectal cancer in Surgical features,postoperative complications,long-term postoperative efficacy and so on which compare with the Traditional laparoscopic abdomino-perineal resection(APR)Metho:Searching the Pubmed、CKNI、WF Similarity Detection and so on,collecting all the articles about comparing the safety and effectiveness of the laparoscopic total mesenteric resection(TME)combined and intersphincteric resection(ISR)with the Traditional laparoscopic abdomino-perineal resection(APR)in the operation of ultra-low rectal cancer from January 2009 to January 2019.Getting all the articles by preliminary searching,and then setting the standards.After that we choose all the articles we need according to the standards and evaluate the quality of the articles.After all the things done,we get the articles we need finally.Reading the articles carefully,collectting the messages and using the literature Review Manager5.3software to evaluate them.Result:Including 16 articles,total 2743 patients,1439 in laparoscopic TME + anal ISR group,1304 in the laparoscopic APR group,there are 8 observational indicatorsincluded in this analysis such as operation time.Here are the results:1、The operation time of the laparoscopic TME + anal ISR group is about 24.73 minutes longer then the laparoscopic APR group(P<0.00001,OR=24.73,95%CI 18.98,30.47),;2、The hospitalization days of laparoscopic TME+ISR was 1.64 days less then the laparoscopic ARP(P<0.00001,OR=-1.64,95%CI-2.10,1.19),;3、The number of lymph node dissection of laparoscopic TME+ISR group is 1.10 less then the laparoscopic APR group(P<0.0001,OR=-1.10,95%CI-1.58,0.61);4、Recurrence and metastasis of cancer in stageIII are different,the laparoscopic TME+ISR group is about 9% higher then the laparoscopic APR group(P=0.01<0.05,RD=0.09,95%CI0.02-0.17),however there are no difference in stageI(P=0.14>0.05,RD=0.04,95%CI-0.01-0.09)and stageII(P=0.51>0.05,RD=0.02,95%CI-0.04,0.09);5、The 5-year overall survival rate of the laparoscopic TME+ISR group is 7% higher then the laparoscopic APR group(RD=0.07,95%CI[0.03,0.12],P=0.001<0.05).6、 There were no significant differences between the two groups in the positive margins(P=0.08 >0.05,RD=-0.02,95%CI-0.04,0.00)and urination dysfunction(P=0.12 >0.05,RD=-0.03,95%CI-0.06,0.01).7 、 The anus’ function of the laparoscopic TME+ISR group after 12 months from operation: 5 articles with 290 people using Kirwan grading assessment,10 patients live without anus because the anus was useless,anther 280 patients’ Kirwan level:243 patients in Ⅰ and Ⅱ(83.8%),28 patients in Ⅲ(9.7%),9 patients in Ⅳ(3.1%);8 articles with 789 patients use Wexner scoring scale,and the average Wexner score was 8.41 < 10,111 patients failed to use anus defecate(14.1%)the rate of anal preservation was 85.9%Conclusions:1.Ultra-low ultra low rectal cancer patients with TNM stage in Ⅰand Ⅱ can get the same radical cure who did laparoscopic total mesenteric resection(TME)+intersphincteric resection(ISR)when comparing with laparoscopic abdomino-perineal resection(APR),and the anal’s function was satisfied for patients.2.However,the patients who did laparoscopic total mesenteric resection(TME)+intersphincteric resection(ISR)with TNM stage in Ⅲ can not get the same radical cure when comparing with the patients who did laparoscopic abdomino-perinealresection(APR).it’s recurrence is higher then APR.3.The function of patients’ anus are satisfied with laparoscopic total mesenteric resection(TME)+ intersphincteric resection(ISR). |
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