同时性结肠直肠癌切除和肝转移病灶手术时机的荟萃分析

Outcome of simultaneous vs staged resections for colorectal cancerand its liver metastasis (metastases):a meta-analysis

目的:探讨同时性结肠直肠癌切除和肝转移病灶的最佳手术时机选择。方法:通过检索电子数据库,对1966年至2009年结肠直肠癌和肝转移灶行同期或分期切除的对照研究资料进行荟萃分析。结果:共纳入14篇文献,2 204例病人。荟萃分析结果显示,同期切除组与分期切除组比较,手术时间和术中出血方面两组间均无统计学差异(P>0.05);同期切除组住院时间较短(P<0.01),手术相关并发症率较低(P<0.01),差异有统计学意义。两者在术后1年、3年和5年生存率方面均无统计学差异(P>0.05)。结论:与分期切除相比,同时性行结肠直肠癌和肝转移灶切除同样安全、有效。

Objective The aim of this meta-analysis is to compare the outcome between simultaneous and staged resections of the primary tumor and its liver metastasis（es） from all published studies in the literature.Methods Databases from Pubmed,medline,Embase,Cochrane Library,Ovid and Web of Science,were searched to compare the outcome following simultaneous resections with staged resections for SCLM.The meta-analysis was performed by RevMan 4.2.Results Fourteen comparative studies comprising 2204 patients were studied.Patients undergoing simultaneous resections were found to experience similar operative time and intra-operative blood loss（P〉0.05）.A shorter hospital stay（P〈0.01） and a lower morbidity rate（P〈0.01） were observed in the simultaneous resections group.The survival rate in the simultaneous resections group did not statistically differ with that of the staged resections group at 1 year,3 years and 5 years（P〉0.05） post-operative respectively.Conclusions Simultaneous resections are safe and efficient in the treatment of patients with SCLM while avoiding a second major operation.In appropriately selected patients,simultaneous resections might be considered as the preferred approach.