Abstract
Aim To compare the clinical efficacies between laparoscopic and conventional open surgery in lateral lymph node dissection (LLND) for advanced rectal cancer. Methods We comprehensively searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data and performed a cumulative meta-analysis. According to inclusion criteria and exclusion criteria, all eligible randomized controlled trials (RCTs) or retrospective or prospective comparative studies assessing the two techniques were included, and then a meta-analysis was performed by using RevMan 5.3 software to assess the difference in clinical and oncological outcomes between the two treatment approaches. Results Eight studies involving a total of 892 patients were finally selected, with 394 cases in the laparoscopic surgery group and 498 cases in the traditional open surgery group. Compared with the traditional open group, the laparoscopic group had a longer operative time (WMD = 81.56, 95% CI (2.09, 142.03), P = 0.008), but less intraoperative blood loss (WMD = −452.18, 95% CI (-652.23, -252.13), P < 0.00001), shorter postoperative hospital stay (WMD = −5.30, 95% CI (-8.42, -2.18), P = 0.0009), and higher R0 resection rate (OR = 2.17, 95% CI (1.14, 4.15), P = 0.02). There was no significant difference in the incidence of surgical complications between the two groups (OR = 0.52, 95% CI (0.26, 1.07), P = 0.08). Lateral lymph node harvest, lateral lymph node metastasis, local recurrence, 3-year overall survival, and 3-year disease-free survival did not differ significantly between the two approaches (P > 0.05). Conclusion Laparoscopic LLND has a similar efficacy in oncological outcomes and postoperative complications to the conventional open surgery, with the advantages of reduced intraoperative blood loss, shorter postoperative hospital stay, and higher R0 resection rate, and tumor radical cure is similar to traditional open surgery. Laparoscopic LLND is a safe and feasible surgical approach, and it may be used as a standard procedure in LLND for advanced rectal cancer.
Highlights
Compared with colon cancer, patients with rectal cancer often undergo local recurrence after radical surgery, which affects the prognosis and seriously threatens the quality of life of patients
The study selection process is shown in the flow-process diagram (Figure 1). 93 publications related to the initial inspection and 21 duplicate publications were eliminated by using EndNote X8 software combined with manual checking. 34 were excluded after skimming through titles and abstracts
According to Japanese reports, even though bilateral lymph node was defined negatively by computed tomography (CT) scanning or magnetic resonance imaging (MRI) for the patients of low rectal cancer, 7.4% of patients in the lateral lymph node dissection (LLND) group were found to have lateral lymph node metastasis (LLNM) [23], while the patients in whom total mesorectal excision (TME) + LLND was performed had a local recurrence rate reduced by about 50% and the 5-year survival rate of patients with rectal cancer increased by 8-9% [7, 23, 24]
Summary
Patients with rectal cancer often undergo local recurrence after radical surgery, which affects the prognosis and seriously threatens the quality of life of patients. Whether laparoscopic LLND can be used as an alternative surgical method for LLND is still controversial, some short-term superior outcomes have been reported in some studies of laparoscopic LLND versus open LLND, such as less blood loss, reduced complication rates, and shorter recovery periods [8,9,10]. Most of these reports are defective, such as a majority of retrospective studies, small sample size, a lack of long-term observations, and contradictory results between the different studies. Laparoscopic LLND has not been well resolved in these studies, and it remains to be determined whether laparoscopic LLND is safe and feasible in clinical and oncological outcomes
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