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Intervention Review

Laparoscopic versus open total mesorectal excision for rectal cancer

  1. Stephanie Breukink1,*,
  2. Jean-Pierre Pierie2,
  3. Theo Wiggers3

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 9 AUG 2006

DOI: 10.1002/14651858.CD005200.pub2


How to Cite

Breukink S, Pierie JP, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005200. DOI: 10.1002/14651858.CD005200.pub2.

Author Information

  1. 1

    Groningen University Hospital, Dept. of Surg., Groningen, Netherlands

  2. 2

    Medical Centre Leeuwarden, Department of Surgery, Leeuwarden, Netherlands

  3. 3

    Academic Hospital Groningen, Department of Surgical Oncology, RG Groningen, Netherlands

*Stephanie Breukink, Dept. of Surg., Groningen University Hospital, Hanzeplein 1, 9700 RB, Groningen, 30001, Netherlands. s.breukink@planet.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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This is not the most recent version of the article. View current version (15 APR 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Because definitive long-term results are not yet available, the oncological safety of laparoscopic surgery for treatment of rectal cancer remains controversial. However, laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short- term advantages in comparison with open total mesorectal excision (OTME).

Objectives

To evaluate whether there are any relevant differences in safety and efficacy after elective LTME, for the resection of rectal cancer, compared with OTME.

Search methods

We searched MEDLINE, EMBASE, Cochrane Central register of Controlled Trials (CENTRAL), and Current Contents from 1990 to December 2005. Searches were conducted using MESH terms: "laparoscopy", "minimally invasive","colorectal neoplasms". Furthermore we used the following text words: laparoscopy, surgical procedures, minimally invasive, rectal cancer, rectal carcinoma, rectal adenocarcinoma, rectal neoplasms, anterior resection, abdominoperineal resection, total mesorectal excision.

Selection criteria

We included randomised controlled trials (RCTs), controlled clinical trials and case series comparing LTME versus OTME. Furthermore case reports which describe LTME were also included.

Data collection and analysis

Two reviewers independently assessed study quality. All relevant studies have been categorized according to the evidence they provide according to the guidelines for "Levels of Evidence and Grades of Recommendation" supplied by the "Oxford Centre for Evidence-based Medicine". Disagreements were solved by discussion.

Main results

80 studies were identified of which 48 studies, representing 4224 patients, met the inclusion criteria. Methodological quality of most of the included studies was poor; three studies were grade 1b (individual randomised trial), 12 grade 2b (individual cohort study), 5 grade 3b (individual case-control study) and 28 grade 4 (case-series). As only one RCT described primary outcome, 3-year and 5-year disease-free survival rates, no meta-analyses could be performed. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, morbidity, anastomotic leakage, resection margins, or recovered lymph nodes were found. There is evidence that LTME results in less blood loss, quicker return to normal diet, less pain, less narcotic use and less immune response. It seems likely that LTME is associated with longer operative time and higher costs. No results of quality of life were reported.

Authors' conclusions

Based on evidence mainly from non-randomized studies, LTME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer. The long-term impact on oncological endpoints awaits the findings from large on-going randomized trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Laparoscopic versus open total mesorectal excision for rectal cancer

We have reviewed all studies that report on safety and efficacy after elective laparoscopic Total Mesorectal Excision (LTME) for the resection of rectal cancer. This review include 48 studies, identified from 80 references retrieved until December 2005. As only one RCT described primary outcome, 3-year and 5-year disease-free survival rates, no meta-analyses could be performed. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, morbidity, anastomotic leakage, resection margins, or recovered lymph nodes were found. There is evidence that LTME results in less blood loss, quicker return to normal diet, less pain, less narcotic use and less immune response. It seems likely that LTME is associated with longer operative time and higher costs. No results of quality of life were reported. The limited evidence suggests that LTME has clinically relevant short-term advantages in selected patients with rectal cancer.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

腹腔鏡手術和全直腸系膜切除手術(total mesorectal excision,TME)對於直腸癌的治療效果

由於目前缺乏明確的長期治療結果,所以使用腹腔鏡手術治療直腸癌的腫瘤的安全性仍具有爭議。然而,目前認為相較於開放性全直腸繫膜切除(open total mesorectal excision,PTME),使用腹腔鏡全直腸繫膜切除(laparoscopic total mesorectal excision,LTME)對於治療直腸癌具有一些短期的效益。

目標

本研究的主要目的在於評估選用LTME和OTME方法進行大腸癌切除,在安全性及有效性的相關差異。

搜尋策略

我們檢索了MEDLINE、EMBASE、Cochrane Central register of Controlled Trials (CENTRAL)和新到期刊,檢索的時間範圍由1990至2005年12月,檢索時會使用MESH的用字:腹腔鏡(“laparoscopy”)、微創(“minimally invasive”)、大腸癌(“colorectal neoplasms”),此外,我們也使用下列關鍵字:腹腔鏡(laparoscopy)、手術過程(surgical procedures)、微創(minimally invasive)、大腸癌(rectal cancer)、大腸癌(rectal carcinoma)、大腸腺癌(rectal adenocarcinoma)、大腸癌(rectal neoplasms)、前位切除(anterior resection)、腹會陰切除術(abdominoperineal resection)、全直腸繫膜切除(total mesorectal excision)。

選擇標準

我們的研究中納入了隨機對照試驗、對照性臨床試驗和針對LTME和OTME進行個案比較,更多針對LTME進行描述的案例報告也被納入本研究中。

資料收集與分析

有2個審閱者會分別評估試驗品質,所有相關的試驗也會依據英國牛津實證醫學研究中心(Centre for EvidenceBased Medicine)公布的「症狀強度和建議等級(Levels of Evidence and Grades of Recommendation)」中規範的指導方針進行症狀的分類,若意見有出入則透過討論解決。

主要結論

總共找出80個試驗,其中的48個含有4224名患者的試驗符合本研究的納入標準,所納入研究的方法學品質都不佳,有3個試驗的方法學品質等級為1b(個別隨機試驗)、有12個試驗等局為2b(個別的b群體性試驗)、個試驗等級為3(個別沒有對照個案的試驗),而有28個試驗等級為4(系列型病例),只有1個隨機對照試驗有呈現出主要成果,以及3年和5年無病存活率,但試驗中並沒有呈現統合分析(metaanalyses)的結果。在無病存活率、局部復發率、死亡率、發病率、吻合處滲透、切除邊或是淋巴結復原等因素上都沒有發現顯著差異,有證據顯示LTME會降低血液流失、較快回復至正常飲食、較少疼痛、較少使用麻醉劑,也較少出現免疫反應,看起來似乎LTME會具有較長的手術時間和較高的花費,試驗中並沒有提及有關生活品質相關的數據。

作者結論

基於由非隨機試驗得到的主要證據顯示,LTME對於以大腸癌切除為主要治療策略的患者來說,似乎較具有在臨床尚可量測的的短期效應,至於長期性對於癌症終止點的影響則仍有待持續中的大型隨機試驗來說明。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

我們回顧了所有提及以選擇性LTME進行大腸癌切除的相關安全性和有效性報告,本研究包括了由80個參考文獻所挑選出的48個試驗,參考文獻的篩選時間至2005年12月為止,其中只有1個RCT試驗有針對主要成果、3年和5年的無病存活率,但試驗中並沒有呈現統合分析的結果,不同組別在無病存活率、局部復發率、死亡率、發病率、吻合處滲透、切除邊緣或是淋巴結復原等成果並沒有出現顯著差異,有證據顯示,使用LTME方法會降低出血、較快恢復至正常飲食、較少疼痛和使用麻醉藥、以及較少出現免疫反應,看起來似乎LTME會花費較多的手術時間以及醫療成本,試驗中沒有討論關於關生活品質的數據。有限的證據顯示LTME對於患有大腸癌的患者來說,在臨床上具有短期效益。