Meta Analysis Of Laparoscopic Versus Open Intersphincteric Resection's Clinical Efficacy In Low Rectal Cancer

Objective:To explore the clinical efficacy of intersphincteric resection in laparoscopic surgery and open surgery for low rectal cancer.Methods:Search and collect the clinical research data of 2010.01 to 2019.01 in the Chinese and English databases such as PubMed,Medline,Ovid,Cochrane Library and ZhiWang,Wanfang,etc.for the treatment of low rectal cancer.After the literatures that meet the literature quality evaluation criteria were included,the meta-analysis was performed using a fixed effect model or a random effects model,depending on the heterogeneity of the study.In the end,we selected 13 articles and a total of 1425 patients.In laparoscopic intersphincteric resection,(LAP-ISR)group(experimental group),there was a total of 786 cases of patients.And in open intersphincteric resection,(OP-ISR)group(control group)?639 cases were included.The evaluation indicators included:operation time,intraoperative blood loss,number of lymph node dissection,postoperative anal exhaust time,postoperative hospital stay,postoperative incision infection,postoperative anastomotic leakage,postoperative anastomotic stenosis,postoperative local recurrence,distant metastasis,and positive rate of circumferential marginResults:A total of 1425 patients were enrolled in 13 observational studies,with 786 patients in the laparoscopic intersphincteric resection(LAP-ISR)group and 639 patients in the open intersphincteric resection(OP-ISR)group.Compared with the control group(open intersphincteric resection),there was no significant difference in the operation time and number of lymph node dissection between the experimental group(laparoscopic intersphincteric resection)(P>0.05).There was a statistically significant difference in the amount of intraoperative blood loss,postoperative anal exhaust time,and postoperative hospital stay between the two groups.The intraoperative blood loss was lower in the experimental group than in the control group(WMD=-100.27,95%CI-123.64 to 76.90,P<0.01).The postoperative anal exhaust time(WMD=-1.03,95%CI-1.42?0.64,P<0.01)was shortened,and the postoperative hospital stay(WMD=-3.28,95%CI-4.40?2.16,P<0.01)was also shortened.There were no significant differences in incidence of postoperative incision infection,anastomotic leakage,anastomotic stenosis,local recurrence rate,distant metastasis rate,and positive rate of circumferential margin(P>0.05).Conclusion:Meta-analysis results showed that for patients with low rectal cancer,the laparoscopic intersphincteric resection's operation time was not significantly longer than the open intersphincteric resection.The number and extent of lymph nodes were similar.And the intraoperative blood loss was reduced,so the laparoscopic surgery was less traumatic than the open group to the patients.The postoperative anal exhaust time and length of hospital stay in the experimental group were shorter than those in the control group,indicating that the postoperative recovery of the laparoscopic group was significantly better than that of the open group,which was more in line with the concept of "enhanced recovery after surgery".There were no significant differences in postoperative complications between the two groups,including incidence of postoperative incision infection,anastomotic leakage,anastomotic stenosis,local recurrence rate,distant metastasis rate,and positive rate of circumferential margin.lt shows that there was no significant difference between the experimental group and the control group in the control of postoperative complications.In general,laparoscopic intersphincteric resection has a better application prospect than the open group,which can provide patients with less trauma,faster recovery and better postoperative quality of life while curing tumors.It is a minimally invasive and safe method of anal preservation surgery.