Laparoscopic procedure is associated with lower morbidity for simultaneous resection of colorectal cancer and liver metastases: an updated meta-analysis

World Journal of Surgical Oncology

Chenhao Tong¹  Xiujun Cai²  Shufeng Wang²  Sarun Juengpanich²  Qiuxia Gu²  Zhiyu Jiang²  Jing Fang²  Long Pan²  Siyuan Fu³ 

[1] Department of General Surgery, Shaoxing People’s Hospital, Zhejiang University School of Medicine, 312000, Shaoxing, China;Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Department of General Surgery, Sir Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China;Zhejiang Province Medical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases, 310016, Hangzhou, China;Institute of Minimally Invasive Surgery of Zhejiang University, 310016, Hangzhou, China;The Third Clinical Medical College, Zhejiang University School of Medicine, 310016, Hangzhou, China;

关键词: Colorectal cancer;    Synchronous liver metastasis;    Laparoscopy;    Meta-analysis;   

DOI  :  10.1186/s12957-020-02018-z

来源: Springer

【 摘 要 】

BackgroundIt has been demonstrated that simultaneous resection of both primary colorectal lesion and metastatic hepatic lesion is a safe approach with low mortality and postoperative complication rates. However, there are some controversies over which kind of surgical approach is better. The aim of study was to compare the efficacy and safety of laparoscopic surgeries and open surgeries for simultaneous resection of colorectal cancer (CRC) and synchronous colorectal liver metastasis (SCRLM).MethodsA systemic search of online database including PubMed, Web of Science, Cochrane Library, and Embase was performed until June 5, 2019. Intraoperative complications, postoperative complications, and long-term outcomes were synthesized by using STATA, version 15.0. Cumulative and single-arm meta-analyses were also conducted.ResultsIt contained twelve studies with 616 patients (273 vs 343, laparoscopic surgery group and open surgery group, respectively) and manifested latest surgical results for the treatment of CRC and SCRLM. Among patients who underwent laparoscopic surgeries, they had lower rates of postoperative complications (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), less intraoperative blood loss (weight mean difference (WMD) = − 113.31, 95% CI: − 189.03 to − 37.59, P = 0.003), less time in the hospital and recovering after surgeries (WMD = − 2.70, 95% CI: − 3.99 to − 1.40, P = 0.000; WMD = − 3.20, 95% CI: − 5.06 to − 1.34, P = 0.001), but more operating time (WMD = 36.57, 95% CI: 7.80 to 65.35, P = 0.013). Additionally, there were no statistical significance between two kinds of surgical approaches in disease-free survival and overall survival. Moreover, cumulative meta-analysis indicated statistical difference in favor of laparoscopic surgery in terms of morbidity was firstly detected in the 12th study in 2018 (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028) as the 95% CI narrowed.ConclusionCompared with open surgeries, laparoscopic surgeries are safer (postoperative complications and intraoperative blood loss) and more effective (length of hospital stay and postoperative stay), and it can be considered as the first option for management of SCRLM in high-volume laparoscopic centers.Trial registrationCRD42020151176

【 授权许可】

CC BY