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目的评价直肠癌侧方淋巴结清扫(lateral lymph node dissection,LLND)对患者术后5年生存率和局部复发率的影响,为直肠癌根治性手术中是否应常规进行侧方淋巴结清扫提供临床依据。方法利用meta分析的方法综合评价国内外公开发表的所有关于直肠癌侧方淋巴结清扫与局部复发率、5年生存率关系的文献。结果筛选出符合入选和排除标准的文献8篇,共4648例,其中LLND组2249例,LLND组5年生存率与非LLND组比较,合并值ORs为1.07(95%CI=0.80~1.42,P=0.67),局部复发率合并值ORs为0.85(95%CI=0.51~1.39,P=0.51)。结论直肠癌侧方淋巴结清扫并不能提高患者的5年生存率,亦不能降低局部复发率。
Objective To evaluate the effect of lateral lymph node dissection (LLND) on the postoperative 5-year survival and local recurrence of patients with rectal cancer, and to provide a clinical basis for routine lateral lymph node dissection in radical surgery of rectal cancer. Methods Meta-analysis was used to evaluate all the published articles published at home and abroad on the relationship between local lymph node dissection and local recurrence and 5-year survival rate. Results A total of 4648 articles were screened for inclusion and exclusion criteria. Among them, 2249 cases in LLND group and 5 years survival rate in LLND group were significantly higher than those in non-LLND group (OR = 1.07, 95% CI = 0.80-1.42, P = 0.67). The ORs of the local recurrence rates were 0.85 (95% CI = 0.51-1.39, P = 0.51). Conclusions Lateral lymphadenectomy of rectal cancer does not improve the 5-year survival rate of patients and can not reduce the local recurrence rate.