Bell Stephen, Kong Joseph C, Carne Peter W G, Chin Martin, Simpson Paul, Farmer Chip, Warrier Satish K
Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2019 Dec;89(12):1549-1555. doi: 10.1111/ans.15081. Epub 2019 Apr 15.
Colorectal cancer resection in the obese (OB) patients can be technically challenging. With the increasing adoption of laparoscopic surgery, the benefits remain uncertain. Hence, the aim of this study is to assess the short- and long-term outcomes of laparoscopic compared to open colorectal cancer resection in the OB patients.
A systematic review and meta-analysis was performed according to the PRISMA guidelines. The outcome measures were 5-year disease-free survival, overall survival, circumferential resection margin and local and distant recurrence.
A total of 20 studies were included, with a total number of 6779 participants, of whom 1785 (26.3%) were OB and 4994 (73.7%) were non-obese (NOB) participants. The OB patients had higher R1 resection (OB 6.9% versus NOB 3.1%; P = 0.011) and lower mean number of lymph nodes harvested, with standard mean difference of -0.29; P = 0.023, favouring the NOB patients. However, there was no statistical difference for local (OB 2.8% versus NOB 3.4%) or distant recurrence (OB 12.9% versus NOB 15.2%) rate between the two cohorts. There was no difference in 5-year disease-free survival (OB 81% versus NOB 77.4%; odds ratio 1.25, P = 0.215) and overall survival (OB 89.4% versus NOB 87.9%; odds ratio 1.16, P = 0.572). Lastly, the OB group had higher mean total blood loss, total operative time and length of hospital stay when compared to NOB patients.
From a pooled non-randomized study, laparoscopic colorectal cancer resection is safe in OB patients with equivalent long-term outcomes compared to NOB patients. However, there is a higher morbidity rate with an increased demand on hospital resources for the OB cohort.
肥胖患者的结直肠癌切除术在技术上可能具有挑战性。随着腹腔镜手术的日益普及，其益处仍不确定。因此，本研究的目的是评估肥胖患者腹腔镜结直肠癌切除术与开放手术相比的短期和长期结果。
根据PRISMA指南进行系统评价和荟萃分析。结局指标为5年无病生存率、总生存率、环周切缘以及局部和远处复发情况。
共纳入20项研究，参与者总数为6779人，其中1785人（26.3%）为肥胖患者，4994人（73.7%）为非肥胖患者。肥胖患者的R1切除率较高（肥胖患者为6.9%，非肥胖患者为3.1%；P = 0.011），且平均获取的淋巴结数量较少，标准化平均差为-0.29；P = 0.023，非肥胖患者更具优势。然而，两组之间的局部复发率（肥胖患者为2.8%，非肥胖患者为3.4%）或远处复发率（肥胖患者为12.9%，非肥胖患者为15.2%）无统计学差异。5年无病生存率（肥胖患者为81%，非肥胖患者为77.4%；比值比为1.25，P = 0.215）和总生存率（肥胖患者为89.4%，非肥胖患者为87.9%；比值比为1.16，P = 0.572）也无差异。最后，与非肥胖患者相比，肥胖组的平均总失血量、总手术时间和住院时间更长。
从一项汇总的非随机研究来看，肥胖患者行腹腔镜结直肠癌切除术是安全的，与非肥胖患者相比长期结局相当。然而，肥胖患者队列的发病率较高，对医院资源的需求也增加。
