Efficacy Of Transanal Specimen Extraction Surgery And Conventional Laparoscopic Surgery For Rectal Cancer:A Meta Analysis

Objective: To evaluate the safety and feasibility of laparoscopic rectal cancer resection through the anus and traditional abdominal auxiliary incision.Methods: According to the research of laparoscopic rectal cancer resection with specimens taken from the anus published from January 2010 to December 2019,compared with traditional laparoscopic treatment of rectal cancer.According to the original literature inclusion criteria and exclusion criteria,the retrieved literature was screened,and the quality of the included literature was evaluated to obtain the final included analysis literature.Extract the relevant data included in the analysis literature,and use the software Rev Man5.3 for meta-analysis.Results: Nine studies were finally included,including 2 randomized controlled studies with a total of 1115 patients,including 521 cases in the transanal specimen surgery group(TASES group)and 594 cases in the traditional laparoscopic surgery group(TLS group).Meta analysis results showed that the operation time(MD=5.58,95%CI=-10.92～22.08,P=0.08)was not statistically significant in the two groups;the intraoperative blood loss in the TASES group was less than that in the TLS group(MD=-10.42,95%CI=-18.90～-1.95,P=0.02),number of lymph node dissections(MD=-0.29,95%CI=-0.80～0.23,P=0.2),tumor size(SMD=-0.40,95% CI=-0.42～0.34,P=0.85)There was no significant difference between the two groups;the first postoperative anal exhaust time(SMD=-1.14,95%CI=-1.83～-0.44,P=0.001)and the postoperative recovery time of eating(SMD=-0.82,95%CI=-1.68～-0.03,P=0.06),the TASES group was shorter than the TLS group,which was statistically significant(P<0.1);the total postoperative complications in the TASES group were less than the TLS group,the difference was There was statistical significance(OR=0.50,95%CI=0.36-0.71,P<0.05);after subgroup analysis,there were fewer complications in the TASES group than the TLS group,and the difference was statistically significant(OR=0.18,95%CI=0.40-1.56,P=0.0004);anastomotic leakage(OR=0.79,95%CI=0.40～1.56,P=0.50),intestinal obstruction(OR=0.54,95%CI=0.18～1.68,P =0.29)showed that the difference between the two groups was not statistically significant(P>0.1);compared the two groups’ hospital stay(MD=-2.07,95%CI=-2.64～-1.49,P<0.05),there was no significant difference between the two groups in 2 years of follow-up tumor recurrence,and 5 years of disease-free survival.Conclusion: Laparoscopic resection of rectal cancer through anal specimens is longer than traditional abdominal assisted incision specimens.Although the operation time is longer,the amount of blood loss,postoperative exhaust time,bowel recovery time,hospital stay,and total postoperative complications Symptoms have advantages.