荧光引导手术与传统手术治疗结直肠癌的疗效和安全性比较：一项系统评价和荟萃分析
Efficacy and Safety of Fluorescence-Guided Surgery Compared to Conventional Surgery in the Management of Colorectal Cancer: A Systematic Review and Meta-Analysis.
作者信息
Fadel Michael G, Zonoobi Elham, Rodríguez-Luna María Rita, Mishima Kohei, Ris Frédéric, Diana Michele, Vahrmeijer Alexander L, Perretta Silvana, Ashrafian Hutan, Fehervari Matyas
机构信息
Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK.
出版信息
Cancers (Basel). 2024 Oct 2;16(19):3377. doi: 10.3390/cancers16193377.
BACKGROUND
The use of fluorescence agents and imaging systems is a promising adjunct in the surgical management of colorectal cancer. This systematic review and meta-analysis aimed to assess the safety and efficacy of fluorescence-guided surgery in the management of colorectal cancer, with a comparison to conventional (non-fluorescence-guided) surgery.
METHODS
A literature search of MEDLINE, Embase, Emcare, and CINAHL databases was performed for studies that reported data on the outcomes of fluorescence-guided surgery, with or without a comparison group undergoing conventional surgery, for colorectal cancer between January 2000 and January 2024. A meta-analysis was performed using random-effect models, and between-study heterogeneity was assessed.
RESULTS
35 studies of 3217 patients with colorectal cancer were included: 26 studies (964 patients) reported on fluorescence-guided surgery and 9 studies (2253 patients) reported on fluorescence versus conventional surgery. The weighted mean of the cancer detection rate of fluorescence-guided surgery was 71% (95% CI 0.55-0.85), with no significant difference in lymph node yield ratio (WMD -0.04; 95% CI -0.10-0.02; = 0.201) between fluorescence and conventional surgery groups. There was a significantly lower blood loss (WMD -4.38; 95% CI -7.05--1.70; = 0.001) and complication rate (WMD -0.04; 95% CI -0.07-0.00; = 0.027) in the fluorescence-guided surgery group, with a potentially lower anastomotic leak rate (WMD -0.05; 95% CI -0.10-0.01; = 0.092).
CONCLUSIONS
Fluorescence-guided surgery is a safe and effective approach in the management of colorectal cancer, potentially reducing blood loss and complications. Further randomised controlled trials are required comparing fluorescence-guided surgery with conventional surgery to determine its prognostic benefit and where it should precisely fit within the management pathway of colorectal cancer.
背景
荧光剂和成像系统的使用是结直肠癌手术治疗中一种很有前景的辅助手段。本系统评价和荟萃分析旨在评估荧光引导手术在结直肠癌治疗中的安全性和有效性，并与传统（非荧光引导）手术进行比较。
方法
对MEDLINE、Embase、Emcare和CINAHL数据库进行文献检索，以查找2000年1月至2024年1月期间报告荧光引导手术结果的数据的研究，无论是否有接受传统手术的对照组，研究对象为结直肠癌患者。采用随机效应模型进行荟萃分析，并评估研究间的异质性。
结果
纳入了35项针对3217例结直肠癌患者的研究：26项研究（964例患者）报告了荧光引导手术，9项研究（2253例患者）报告了荧光引导手术与传统手术的对比。荧光引导手术的癌症检出率加权平均值为71%（95%CI 0.55 - 0.85），荧光引导手术组与传统手术组之间的淋巴结收获率无显著差异（加权平均差 -0.04；95%CI -0.10 - 0.02；P = 0.201）。荧光引导手术组的失血量（加权平均差 -4.38；95%CI -7.05 - -1.70；P = 0.001）和并发症发生率（加权平均差 -0.04；95%CI -0.07 - 0.00；P = 0.027）显著更低，吻合口漏率可能更低（加权平均差 -0.05；95%CI -0.10 - 0.01；P = 0.092）。
结论
荧光引导手术是结直肠癌治疗中的一种安全有效的方法，可能减少失血量和并发症。需要进一步进行随机对照试验，比较荧光引导手术与传统手术，以确定其预后益处以及在结直肠癌治疗路径中的确切适用位置。
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