背景:盆腔切除术(PE)是一种复杂的多内脏外科手术,适用于局部晚期或复发性盆腔恶性肿瘤。它提出了重大的技术挑战,这些挑战是与手术相关的高发病率和死亡率的原因。微创手术(MIS)方法的发展和增强的围手术期护理促进了长期预后的改善。然而,体育的最佳方法仍然存在争议。
方法:根据PRISMA指南进行了系统的文献检索,以确定比较MIS(机器人或腹腔镜)入路与开放入路治疗局部晚期或复发性盆腔恶性肿瘤的研究。对纳入研究的方法学质量进行了系统评价,并进行了荟萃分析。
结果:确定了11项研究,包括2009年的病人,其中264人(13.1%)接受了MISPE方法。MIS组显示出可比的R0切除(风险比[RR]1.02,95%置信区间[95%CI]0.98,1.07,p=0.35)和淋巴结产量(加权平均差[WMD]1.42,95%CI-0.58,3.43,p=0.16),尽管MIS有改善生存率和复发结局的趋势,这没有达到统计学意义。MIS与手术时间延长相关(WMD67.93,95%CI4.43,131.42,p<0.00001),这与术中失血减少有关,术后住院时间较短(WMD-3.89,955CI-6.53,-1.25,p<0.00001)。MIS的再入院率较高(RR2.11,95%CI1.11,4.02,p=0.02),然而,盆腔脓肿/脓毒症的发生率降低(RR0.45,95%CI0.21,0.95,p=0.04),总体上没有区别,major,或特定的发病率和死亡率。
结论:MIS方法是PE安全可行的选择,与开放方法相比,生存率或复发结局无差异。MIS还减少了术后住院时间,减少了失血,被增加的操作时间所抵消。
Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for locally advanced or recurrent pelvic malignancies. It poses significant technical challenges which account for the high risk of morbidity and mortality associated with the procedure. Developments in minimally invasive surgical (MIS) approaches and enhanced peri-operative care have facilitated improved long term outcomes. However, the optimum approach to PE remains controversial.
A systematic literature search was conducted in accordance with PRISMA guidelines to identify studies comparing MIS (robotic or laparoscopic) approaches for PE versus the open approach for patients with locally advanced or recurrent pelvic malignancies. The methodological quality of the included studies was assessed systematically and a meta-analysis was conducted.
11 studies were identified, including 2009 patients, of whom 264 (13.1%) underwent MIS PE approaches. The MIS group displayed comparable R0 resections (Risk Ratio [RR] 1.02, 95% Confidence Interval [95% CI] 0.98, 1.07, p = 0.35)) and Lymph node yield (Weighted Mean Difference [WMD] 1.42, 95% CI -0.58, 3.43, p = 0.16), and although MIS had a trend towards improved towards improved survival and recurrence outcomes, this did not reach statistical significance. MIS was associated with prolonged operating times (WMD 67.93, 95% CI 4.43, 131.42, p < 0.00001) however, this correlated with less intra-operative blood loss, and a shorter length of post-operative stay (WMD -3.89, 955 CI -6.53, -1.25, p < 0.00001). Readmission rates were higher with MIS (RR 2.11, 95% CI 1.11, 4.02, p = 0.02), however, rates of pelvic abscess/sepsis were decreased (RR 0.45, 95% CI 0.21, 0.95, p = 0.04), and there was no difference in overall, major, or specific morbidity and mortality.
MIS approaches are a safe and feasible option for PE, with no differences in survival or recurrence outcomes compared to the open approach. MIS also reduced the length of post-operative stay and decreased blood loss, offset by increased operating time.