腹腔镜与开腹手术治疗结肠癌远期疗效的Meta分析

A Meta-analysis of the long-term outcomes of laparoscopic and open surgery for colonic cancer

目的:对比腹腔镜手术与开腹手术治疗结肠癌的远期疗效。方法:检索CHKD、维普数据库、PUBMED、EMCC、Ovid等数据库1995年1月至2011年7月收录的对比腹腔镜手术与开腹手术治疗结肠癌远期疗效的随机对照研究。制定文献纳入与剔除标准,严格按标准筛选文献,并用Jadad量表评估入选研究的质量。从文献提取数据,用RevMan4.2.8进行统计分析。结果:按筛选标准,共8篇2689例结肠癌患者入选(腹腔镜手术1347例,开腹手术1342例)。腹腔镜手术组与开腹手术组两组患者基本数据除体重指数外,性别、年龄、肿瘤TNM分期与ASA分级差异均无统计学意义。腹腔镜手术治疗结肠癌与开腹手术相比,复发率、局部复发率、远处转移率、穿刺孔或切口种植转移率、3年生存率、5年生存率、3年无瘤生存率、5年无瘤生存率差异均无统计学意义。结论:腹腔镜手术治疗结肠癌的远期疗效与开腹手术相当。腹腔镜手术可作为治疗结肠癌的标准术式。

Objective：To compare the long-term outcomes of laparoscopic surgery and open surgery for colonic cancer. Methods：The randomized controlled trials between Jan. 1995 and Jul. 2011 ,reported on the long-term outcomes of laparoscopic versus open surgery for colon cancer,were collected by searches of CHKD, VIP,PUBMED,EMCC and the Ovid database. The standard of literature enrollment and exclusion was made, according to which the literatures were selected. Jadad scale was used to evaluate the chosen study. Data were extracted from these trials and data analysis was performed by RevMan 4.2.8. Results ： According to the same screening criteria,a total of 2 689 patients from 6 trials were included （ 1 347 patients in the laparoscopic surgery group and 1 342 patients in the open surgery group）. Except body mass index,the age,gender,tumor stage and ASA class were similar between the two groups. There was no statistically significant difference in the long-term outcomes between the two groups, including recurrence rate, local recurrence rate, distant metastasis rate, port site or incision implantation metastasis rate, survival rate in 3 years and 5 years, no-tmnor survival rate in 3 years and 5 years. Conclusions：The long-term outcomes are similar between laparoscopic and open surgery for colon cancer. Laparoscopic surgery for colon cancer is an acceptable alternative.