Department of Surgery, University of Catania, Catania, Italy.
Eur Rev Med Pharmacol Sci. 2013 May;17(9):1174-84.
The purpose of this systematic review is to evaluate and compare the risk of dissemination metastasis (wound, port-side metastases and peritoneal seeding) after laparoscopic colorectal surgery and conventional open surgery for colorectal cancer.
The Authors searched relevant randomized controlled trials between January 1998 and July 2012.
Wound, port-site metastases and peritoneal seeding were rare and no significant differences occurred between the two groups. The port-site and extraction site recurrence were likely to be the results of suboptimal surgical techniques and occurred in the early phase of the learning curve. The authors also found no significant differences in overall, local and distant recurrences. No significant differences between laparoscopic and open surgery were found in cancer-related mortality during the follow up period of the study (7 RCTs, 3525 patients, 12.8% vs. 14.00%; OR (fixed) 0.83, 95% CI 0.68-1.02), with no significant heterogeneity (p = 0.35).
The literature supports the implementation of laparoscopic surgery into daily practice. Laparoscopic surgery can be used for safe and radical resection of cancer in the right, left, sigmoid colon and rectum. However further studies should address whether laparoscopic surgery is superior to open surgery in this setting.
本系统评价旨在评估和比较腹腔镜结直肠手术与传统开腹手术治疗结直肠癌的转移扩散（伤口、端口转移和腹膜种植）风险。
作者检索了 1998 年 1 月至 2012 年 7 月间的相关随机对照试验。
伤口、端口转移和腹膜种植较为罕见，两组间无显著差异。端口和提取部位的复发可能是手术技术不佳的结果，且发生在学习曲线的早期。作者还发现两组在总体、局部和远处复发方面无显著差异。在研究随访期间，腹腔镜与开腹手术在癌症相关死亡率方面无显著差异（7 项 RCT，3525 例患者，12.8%比 14.00%；固定 OR 0.83，95%CI 0.68-1.02），无显著异质性（p = 0.35）。
文献支持将腹腔镜手术纳入日常实践。腹腔镜手术可安全彻底切除右、左、乙状结肠和直肠的癌症。然而，还需要进一步的研究来确定腹腔镜手术在这种情况下是否优于开腹手术。
