Chaouch Mohamed Ali, Hussain Mohammad Iqbal, Gouader Amine, Krimi Bassem, Mazzotta Alessandro, Da Costa Adriano Carneira, Seiller Ian, Guibal Aymeric, Rehim Mohamed Abdel, Diana Michele, Marescaux Jacques, Khan Jim, Fattal Wahid, Oweira Hani
Department of visceral and digestive surgery, Monastir University Hospital, Monastir, Tunisia.
Department of Robotic Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom.
J Gastrointest Cancer. 2024 Dec 30;56(1):37. doi: 10.1007/s12029-024-01162-z.
Complete mesocolon excision (CME) and central vascular ligation for right colonic cancers have been developed to improve oncological outcomes. However, it has been linked with a higher risk of morbidity and technical difficulties in operating near major vessels. This study investigated the impact of preoperative surgical planning utilizing CT reconstruction on surgical outcomes in right colectomy with CME.
This systematic review and meta-analysis followed PRISMA and AMSTAR 2 guidelines. The analysis included clinical trials and observational studies comparing outcomes after preoperative CT scan reconstruction (navigation group) vs. no preoperative CT reconstruction (control group).
Four eligible studies (published between 2013 and 2023) were included, comprising 420 patients (203 in the navigation group and 217 in the control group). Preoperative navigation was associated with significantly lower blood loss (SMD = - 77.50; 95% CI [- 126.77, - 28.22], p = 0.002), shorter operative time (SMD = - 24.44; 95% CI [- 33.33, - 15.55], p < 0.00001), and a higher number of harvested lymph nodes (SMD = 1.39; 95% CI [0.58, 2.20], p = 0.0007). There was no statistically significant difference between the two groups in terms of overall morbidity (OR = 0.82; 95% CI [0.28, 2.40], p = 0.71), intraoperative complications (OR = 1.39; 95% CI [0.37, 5.26], p = 0.63), anastomotic leak (OR = 1.10; 95% CI [0.16, 7.63], p = 0.92), or hospital stay (SMD = - 0.06; 95% CI [- 0.48, 0.37], p = 0.80).
Preoperative navigation using CT reconstruction could help better delineate the complex vascular anatomy of the right colon. It may reduce operative time and increase the yield of harvested lymph nodes.
为改善肿瘤学结局，已开展了右半结肠癌的完整结肠系膜切除术（CME）和中央血管结扎术。然而，它与更高的发病风险以及在主要血管附近操作的技术难度相关。本研究调查了利用CT重建进行术前手术规划对CME右半结肠切除术手术结局的影响。
本系统评价和荟萃分析遵循PRISMA和AMSTAR 2指南。分析纳入了比较术前CT扫描重建后（导航组）与未进行术前CT重建（对照组）结局的临床试验和观察性研究。
纳入了四项符合条件的研究（发表于2013年至2023年之间），共420例患者（导航组203例，对照组217例）。术前导航与显著更低的失血量（标准化均数差[SMD]= - 77.50；95%可信区间[- 126.77, - 28.22]，p = 0.002）、更短的手术时间（SMD = - 24.44；95%可信区间[- 33.33, - 15.55]，p < 0.00001）以及更多的清扫淋巴结数量（SMD = 1.39；95%可信区间[0.58, 2.20]，p = 0.0007）相关。两组在总体发病率（比值比[OR]= 0.82；95%可信区间[0.28, 2.40]，p = 0.71）、术中并发症（OR = 1.39；95%可信区间[0.37, 5.26]，p = 0.63）、吻合口漏（OR = 1.10；95%可信区间[
