Postoperative morbidity and mortality after mesorectal excision with laparoscopic versus conventional open lateral lymph node dissection for advanced rectal cancer: A meta-analysis

Asian Journal of Surgery

Daorong Wang¹  Liuhua Wang¹  Rui Du²  Jiajie Zhou²  Changmin Ma²  Jiawen Liu²  Dongliang Li³  Qi Zhang³ 

[1] Department of General Surgery, Northern Jiangsu People’s Hospital, Nantong Road No.98, Yangzhou 225001, China;Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian, 116044, China;Graduate School, Medical College of Yangzhou University, Huaihai Road No.7, Yangzhou 225001, China;

关键词: Lateral lymph node dissection;    Rectal cancer;    Laparoscopy;    Postoperative morbidity;    Meta-analysis;   

DOI  :  

来源: DOAJ

【 摘 要 】

Summary: Lateral lymph node dissection (LLND) is a challenging procedure due to its technical difficulty and higher incidence of surgical morbidity, thus the purpose of this study is to compare the postoperative morbidity and mortality between laparoscopic and conventional open LLND after mesorectal excision (ME) for advanced rectal cancer. A comprehensive search was conducted in August 2019 based on data from PubMed, Embase, Cochrane Library, CNKI and Wanfang Data to identify relevant studies, and studies comparing laparoscopic with conventional open LLND were included. Seven studies with 335 cases in the laparoscopic LLND group and 841 cases in the conventional open LLND group were finally included. Compared with the conventional open LLND group, the laparoscopic LLND group enjoys a lower postoperative morbidity (OR = 0.47,95% CI [0.23, 0.97], P = 0.04), same postoperative mortality (Postoperative mortality in both groups was zero), shorter length of postoperative hospitalization (WMD = −5.30, 95% CI [-8.42, −2.18], P = 0.0009), less wound infection (OR = 0.40,95% CI [0.21, 0.77], P = 0.006), less intestinal obstruction (OR = 0.50,95% CI [0.29, 0.84], P = 0.009), and less urinary retention (OR = 0.61,95% CI [0.38, 0.97], P = 0.04). There were no significant differences in the incidence of anastomotic leakage, abdominal pelvic abscess and urinary tract infection between the two groups (P > 0.05). But in the sensitivity analysis, there was a significant change of urinary tract infection (OR = 0.22, 95%CI [0.06, 0.89], P = 0.03), and the degree of between-study heterogeneity decreased greatly. In conclusion, laparoscopic LLND may be a better alternative to conventional open LLND for advanced rectal cancer with lower postoperative morbidity and shorter postoperative hospital stay.

【 授权许可】

Unknown