背景:自扩张金属支架(SEMS)放置后的手术桥梁(BTS)是一种广泛认可的梗阻性结直肠癌治疗策略。然而,目前仍缺乏关于SEMS置入后腹腔镜手术的有效性和安全性的证据.这项系统评价和荟萃分析的目的是比较腹腔镜手术与开腹手术对梗阻性结直肠癌患者的短期和长期结局。
方法:进行了截至2022年12月的电子文献检索,以确定比较腹腔镜和开腹手术在SEMS放置后治疗梗阻性结直肠癌的短期和长期结果的研究。主要结局指标为术后并发症发生率和死亡率。次要结果指标是3年无复发生存率(RFS)和3年总生存率(OS)。使用固定效应或随机效应方法进行荟萃分析,以95%置信区间(95%CIs)计算比值比(OR)。
结果:荟萃分析包括15项研究和883例患者,其中467人(52.9%)接受了腹腔镜手术,416人(47.1%)在放置SEMS后接受了开腹手术.腹腔镜手术组术后并发症发生率明显低于开腹手术组(OR0.47,95%CI0.32~0.67,P<0.001)。腹腔镜和开腹手术组的3年RFS率或3年OS率无显著差异(3年RFS,OR0.78,95%CI0.50-1.24,P=0.30;3年OS,OR0.68,95%CI0.41-1.12,P=0.13)。
结论:这项荟萃分析发现,在SEMS置入后接受腹腔镜手术的患者的短期预后优于接受开腹手术的患者。此外,两组的长期结局无显著差异.SEMS放置后的腹腔镜手术可能是阻塞性结直肠癌的安全有效治疗选择。
BACKGROUND: A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of
laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of
laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer.
METHODS: An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).
RESULTS: The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the
laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32-0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the
laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50-1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41-1.12, P = 0.13).
CONCLUSIONS: This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups.
Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer.