Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Department of General Surgery, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
Zhejiang Province Medical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases, Hangzhou, 310016, China.
World J Surg Oncol. 2020 Sep 21;18(1):251. doi: 10.1186/s12957-020-02018-z.
It has been demonstrated that simultaneous resection of both primary colorectal lesion and metastatic hepatic lesion is a safe approach with low mortality and postoperative complication rates. However, there are some controversies over which kind of surgical approach is better. The aim of study was to compare the efficacy and safety of laparoscopic surgeries and open surgeries for simultaneous resection of colorectal cancer (CRC) and synchronous colorectal liver metastasis (SCRLM).
A systemic search of online database including PubMed, Web of Science, Cochrane Library, and Embase was performed until June 5, 2019. Intraoperative complications, postoperative complications, and long-term outcomes were synthesized by using STATA, version 15.0. Cumulative and single-arm meta-analyses were also conducted.
It contained twelve studies with 616 patients (273 vs 343, laparoscopic surgery group and open surgery group, respectively) and manifested latest surgical results for the treatment of CRC and SCRLM. Among patients who underwent laparoscopic surgeries, they had lower rates of postoperative complications (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), less intraoperative blood loss (weight mean difference (WMD) = - 113.31, 95% CI: - 189.03 to - 37.59, P = 0.003), less time in the hospital and recovering after surgeries (WMD = - 2.70, 95% CI: - 3.99 to - 1.40, P = 0.000; WMD = - 3.20, 95% CI: - 5.06 to - 1.34, P = 0.001), but more operating time (WMD = 36.57, 95% CI: 7.80 to 65.35, P = 0.013). Additionally, there were no statistical significance between two kinds of surgical approaches in disease-free survival and overall survival. Moreover, cumulative meta-analysis indicated statistical difference in favor of laparoscopic surgery in terms of morbidity was firstly detected in the 12th study in 2018 (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028) as the 95% CI narrowed.
Compared with open surgeries, laparoscopic surgeries are safer (postoperative complications and intraoperative blood loss) and more effective (length of hospital stay and postoperative stay), and it can be considered as the first option for management of SCRLM in high-volume laparoscopic centers.
CRD42020151176.
已经证明，同时切除原发性结直肠病变和转移性肝病变是一种安全的方法，其死亡率和术后并发症发生率较低。然而，对于哪种手术方法更好仍存在一些争议。本研究的目的是比较腹腔镜手术和开放手术同时切除结直肠癌（CRC）和结直肠肝转移同步（SCRLM）的疗效和安全性。
系统检索包括 PubMed、Web of Science、Cochrane Library 和 Embase 在内的在线数据库，检索时间截至 2019 年 6 月 5 日。使用 STATA 版本 15.0 综合术中并发症、术后并发症和长期结果。还进行了累积和单臂荟萃分析。
包含 12 项研究，共 616 例患者（腹腔镜手术组 273 例，开放手术组 343 例），显示了治疗 CRC 和 SCRLM 的最新手术结果。在接受腹腔镜手术的患者中，术后并发症发生率较低（OR=0.66，95%CI：0.46 至 0.96，P=0.028），术中出血量较少（加权均数差值（WMD）=-113.31，95%CI：-189.03 至-37.59，P=0.003），术后住院时间和恢复时间较短（WMD=-2.70，95%CI：-3.99 至-1.40，P=0.000；WMD=-3.20，95%CI：-5.06 至-1.34，P=0.001），但手术时间较长（WMD=36.57，95%CI：7.80 至 65.35，P=0.013）。此外，两种手术方式在无病生存率和总生存率方面无统计学差异。此外，累积荟萃分析表明，腹腔镜手术在发病率方面的优势首先在 2018 年的第 12 项研究中被发现（OR=0.66，95%CI：0.46 至 0.96，P=0.028），因为 95%CI 变窄。
与开放手术相比，腹腔镜手术更安全（术后并发症和术中出血量）且更有效（住院时间和术后住院时间），并且可以在高容量腹腔镜中心考虑作为 SCRLM 治疗的首选方法。
CRD42020151176。
