Zhang Xubing, Wu Qingbin, Gu Chaoyang, Hu Tao, Bi Liang, Wang Ziqiang
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University West China School of Medicine, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2017 Aug;96(33):e7794. doi: 10.1097/MD.0000000000007794.
This meta-analysis aims to compare hand-assisted laparoscopic surgery (HALS) and conventional open surgery (OS) for colorectal cancer (CRC) in terms of intraoperative and postoperative outcomes, and to explore the safety, feasibility of HALS for CRC surgery.
A systematic literature search with no limits was performed in PubMed, Embase, and Medline. The last search was performed on April 23, 2017. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, transfusion, and lymph nodes harvested), postoperative outcomes (length of hospital stay, length of postoperative hospital stay, time to first flatus, time to first liquid diet, time to first soft diet, time to first bowel movement, postoperative complications, reoperation, ileus, anastomotic leakage, wound infection, urinary complication, pulmonary infection, and mortality).
Fifteen articles published between 2007 and 2017 with a total of 1962 patients with CRC were included in our meta-analysis. HALS was associated with longer operative time, less blood loss, smaller length of incision, shorter hospital days and postoperative hospital days, less time to first flatus, less wound infection, and less postoperative complications. There was no difference in blood transfusion, lymph node harvested, time to first liquid or soft diet, time to first bowel movement, reoperation, ileus, anastomotic leakage, pulmonary infection, urinary complications, or mortality.
Our meta-analysis suggests that HALS in CRC surgery improves cosmesis and results in better postoperative recovery outcomes by reducing postoperative complications and hospital days. Furthermore, a large randomized control study is warranted to compare the short-term and long-term outcomes of those 2 techniques for CRC treatment.
本荟萃分析旨在比较手辅助腹腔镜手术（HALS）与传统开放手术（OS）治疗结直肠癌（CRC）的术中和术后结果，并探讨HALS用于CRC手术的安全性和可行性。
在PubMed、Embase和Medline上进行了无限制的系统文献检索。最后一次检索于2017年4月23日进行。感兴趣的结果包括术中结果（手术时间、失血量、切口长度、输血情况和收获的淋巴结数量）、术后结果（住院时间、术后住院时间、首次排气时间、首次流食时间、首次软食时间、首次排便时间、术后并发症、再次手术、肠梗阻、吻合口漏、伤口感染、泌尿系统并发症、肺部感染和死亡率）。
我们的荟萃分析纳入了2007年至2017年发表的15篇文章，共1962例CRC患者。HALS与更长的手术时间、更少的失血量、更小的切口长度、更短的住院天数和术后住院天数、更短的首次排气时间、更少的伤口感染和更少的术后并发症相关。在输血情况、收获的淋巴结数量、首次流食或软食时间、首次排便时间、再次手术、肠梗阻、吻合口漏、肺部感染、泌尿系统并发症或死亡率方面没有差异。
我们的荟萃分析表明，CRC手术中的HALS通过减少术后并发症和住院天数改善了美容效果，并导致更好的术后恢复结果。此外，有必要进行一项大型随机对照研究来比较这两种CRC治疗技术的短期和长期结果。
