腹腔镜与开腹手术治疗T_(4)期结肠癌安全性及远期疗效比较的Meta分析

Meta-analysis of the safety and long-term outcomes of laparoscopic versus open surgery for T_(4) colon cancer

目的:比较腹腔镜与开腹手术治疗T_(4)期结肠癌的手术短期结果与长期肿瘤学结局,为临床决策提供参考。方法:分别检索中国知网、万方医学网、PubMed、Embase、The Cochrane Library数据库的相关文献。应用Review Manager 5.4进行Meta分析。结果:最终纳入21篇文献,共4705例患者,其中腹腔镜组2540例,开腹组2165例。Meta分析结果显示,相较开腹组,腹腔镜组术中出血量更少(WMD=-62.15,95%CI=-76.64~-47.66,P<0.00001),术后住院时间更短(WMD=-2.66,95%CI=-3.65~-1.67,P<0.00001),术后30 d内并发症发生率更低(OR=0.52,95%CI=0.41~0.67,P<0.00001),但手术时间更长(WMD=17.88,95%CI=5.73~30.02,P=0.004)。两组R0切除率(OR=1.31,95%CI=0.91~1.88,P=0.15)、清扫淋巴结数量(OR=-0.83,95%CI=-2.37~0.72,P=0.29)、局部复发率(OR=1.25,95%CI=0.62~2.53,P=0.53)差异均无统计学意义。腹腔镜组术后5年无病生存率较高(OR=1.32,95%CI=1.04~1.67,P=0.02),但两组术后3年总体生存率(OR=1.24,95%CI=0.93~1.66,P=0.14)、3年无病生存率(OR=1.14,95%CI=0.86~1.53,P=0.36)、5年总体生存率(OR=1.20,95%CI=0.97~1.48,P=0.10)差异无统计学意义。结论:腹腔镜技术应用于T_(4)期结肠癌具有良好的安全性与临床疗效,能获得较好的短期效果、更快的术后恢复,不会对长期肿瘤学结局产生不利影响。

Objective:To compare the short-term operative outcome and long-term oncology outcome of laparoscopic and open surgery in the treatment of T_(4) colon cancer,and to provide reference for clinical decision-making.Methods:The relevant literatures in CNKI,Wanfang,PubMed,Embase and The Cochrane Library were searched.Meta-analysis was performed using Review Manager 5.4.Results:Finally,21 studies and 4705 patients were included,there were 2540 patients in the laparoscopic group and 2165 patients in the open group.Meta-analysis showed that compared with the open group,the laparoscopic group had less intraoperative blood loss(WMD=-62.15,95%CI=-76.64~-47.66,P<0.00001),shorter postoperative hospital stay(WMD=-2.66,95%CI=-3.65-~1.67,P<0.00001),and a lower incidence of complications within 30 d after surgery(OR=0.52,95%CI=0.41~0.67,P<0.00001).However,the operative time was longer(WMD=17.88,95%CI=5.73~30.02,P=0.004).There were no significant differences in R0 resection rate(OR=1.31,95%CI=0.91~1.88,P=0.15),number of dissected lymph nodes(OR=-0.83,95%CI=-2.37~0.72,P=0.29)and local recurrence rate(OR=1.25,95%CI=0.62~2.53,P=0.53)between the two groups.For long-term postoperative effect,5-year disease-free survival rate was higher in the laparoscopic group(OR=1.32,95%CI=1.04~1.67,P=0.02),but there was no significant difference in 3-year overall survival rate(OR=1.24,95%CI=0.93~1.66,P=0.14),3-year disease-free survival rate(OR=1.14,95%CI=0.86~1.53,P=0.36),5-year overall survival rate(OR=1.20,95%CI=0.97~1.48,P=0.10)between the two groups.Conclusions:Laparoscopic treatment of T_(4) colon cancer has good safety and clinical efficacy,it can achieve better short-term results,provide faster postoperative recovery,and does not adversely affect long-term oncology outcomes.