Gachabayov Mahir, Kajmolli Agon, Quintero Luis, Felsenreich Daniel M, Popa Dorin E, Ignjatovic Dejan, Bergamaschi Roberto
Department of Surgery, Jacobi Medical Center, New York City Health Hospitals, Building 1, Suite 610, 1400 Pelham Parkway S, New York, NY, USA.
Department of Surgery, New York Medical College, Valhalla, NY, USA.
Langenbecks Arch Surg. 2024 Jan 10;409(1):35. doi: 10.1007/s00423-023-03224-5.
Although laparoscopic lavage for perforated diverticulitis with peritonitis has been grabbing the headlines, it is known that the clinical presentation of peritonitis can also be caused by an underlying perforated carcinoma. The aim of this study was to determine the incidence of patients undergoing inadvertent laparoscopic lavage of perforated colon cancer as well as the delay in cancer diagnosis.
The PubMed database was systematically searched to include all studies meeting inclusion criteria. Studies were screened through titles and abstracts with potentially eligible studies undergoing full-text screening. The primary endpoints of this meta-analysis were the rates of perforated colon cancer patients having undergone inadvertent laparoscopic lavage as well as the delay in cancer diagnosis. This was expressed in pooled rate % and 95% confidence intervals.
Eleven studies (three randomized, two prospective, six retrospective) totaling 642 patients met inclusion criteria. Eight studies reported how patients were screened for cancer and the number of patients who completed follow-up. The pooled cancer rate was 3.4% (0.9%, 5.8%) with low heterogeneity (Isquare2 = 34.02%) in eight studies. Cancer rates were 8.2% (0%, 3%) (Isquare2 = 58.2%) and 1.7% (0%, 4.5%) (Isquare2 = 0%) in prospective and retrospective studies, respectively. Randomized trials reported a cancer rate of 7.2% (3.1%, 11.2%) with low among-study heterogeneity (Isquare2 = 0%) and a median delay to diagnosis of 2 (1.5-5) months.
This systematic review found that 7% of patients undergoing laparoscopic lavage for peritonitis had perforated colon cancer with a delay to diagnosis of up to 5 months.
尽管腹腔镜灌洗治疗伴有腹膜炎的穿孔性憩室炎一直备受关注，但众所周知，腹膜炎的临床表现也可能由潜在的穿孔性癌引起。本研究的目的是确定接受意外腹腔镜灌洗的穿孔性结肠癌患者的发生率以及癌症诊断的延迟情况。
系统检索PubMed数据库，纳入所有符合纳入标准的研究。通过标题和摘要对研究进行筛选，对潜在符合条件的研究进行全文筛选。本荟萃分析的主要终点是接受意外腹腔镜灌洗的穿孔性结肠癌患者的比例以及癌症诊断的延迟情况。以合并率%和95%置信区间表示。
11项研究（3项随机对照研究、2项前瞻性研究、6项回顾性研究）共642例患者符合纳入标准。8项研究报告了患者的癌症筛查方式以及完成随访的患者数量。8项研究的合并癌症率为3.4%（0.9%，5.8%），异质性较低（I²=34.02%）。前瞻性研究和回顾性研究的癌症率分别为8.2%（0%，3%）（I²=58.2%）和1.7%（0%，4.5%）（I²=0%）。随机对照试验报告的癌症率为7.2%（3.1%，11.2%），研究间异质性较低（I²=0%），诊断延迟中位数为2（1.5 - 5）个月。
本系统评价发现，7%接受腹腔镜灌洗治疗腹膜炎的患者患有穿孔性结肠癌，诊断延迟长达5个月。
