背景:据推测,腹腔镜手术(LS)由于手术创伤较轻,导致较温和的促炎反应,这可能有助于LS后观察到的临床益处。然而,以前关于LS对免疫能力影响的系统评价和荟萃分析已经过时,有限和异质。因此,在全面的系统评价和荟萃分析中评估了腹腔镜和开腹结直肠癌(CRC)切除术后的体液反应.
方法:包括随机对照试验(RCTs),其测量了LS后与开放手术(OS)相比,在任何阶段的成年CRC患者中,体液免疫参数。MEDLINE,Embase,WebofScience(SCI-EXPANDED),科克伦图书馆,谷歌学者,系统搜索了ClinicalTrials.gov和ICTRP(世界卫生组织)。使用CochraneRoB2工具评估偏倚风险(RoB)。对C反应蛋白(CRP)、白细胞介素(IL)-6,IL-8,肿瘤坏死因子(TNF)α和血管内皮生长因子(VEGF)使用随机效应方法。方法前瞻性登记在PROSPERO(CRD42021264324)。
结果:纳入了20个RCT,1131名参与者。在手术后8天进行叙事合成和荟萃分析。定量合成发现,在手术后0-2小时LS后浓度显着降低(IL-8),在3-9小时(CRP,IL-6,IL-8,TNFα)和术后第1天(CRP,IL-6、IL-8、VEGF)。在3-9小时,IL-6在LS组中显著降低86.71pg/ml(平均差异[MD]-86.71pg/ml[-125.05,-48.37],p<0.00001)。结合叙述,13项研究报道了LS患者中考虑参数的浓度显着降低,而只有一项研究报告OS后炎症标志物(CRP和IL-6)较低。
结论:在这项荟萃分析中,LS后几种促炎参数的术后浓度增加明显低于OS后。总的来说,总结的证据加强了LS引起的炎症诱导降低的观点.
BACKGROUND: Laparoscopic surgery (LS) is hypothesized to result in milder proinflammatory reactions due to less severe operative trauma, which may contribute to the observed clinical benefits after LS. However, previous systematic reviews and meta-analyses on the impact of LS on immunocompetence are outdated, limited and heterogeneous. Therefore, the humoral response after laparoscopic and open colorectal cancer (CRC) resections was evaluated in a comprehensive systematic
review and meta-analysis.
METHODS: Included were randomized controlled trials (RCTs) measuring parameters of humoral immunity after LS compared to open surgery (OS) in adult patients with CRC of any stage. MEDLINE, Embase, Web of Science (SCI-EXPANDED), Cochrane Library, Google Scholar, ClinicalTrials.gov and ICTRP (World Health Organization) were systematically searched. Risk of bias (RoB) was assessed using the Cochrane RoB2 tool. Weighted inverse variance meta-analysis of mean differences was performed for C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) using the random-effects method. Methods were prospectively registered in PROSPERO (CRD42021264324).
RESULTS: Twenty RCTs with 1131 participants were included. Narrative synthesis and meta-analysis up to 8 days after surgery was performed. Quantitative synthesis found concentrations to be significantly lower after LS at 0-2 h after surgery (IL-8), at 3-9 h (CRP, IL-6, IL-8, TNFα) and at postoperative day 1 (CRP, IL-6, IL-8, VEGF). At 3-9 h, IL-6 was notably lower in the LS group by 86.71 pg/ml (mean difference [MD] - 86.71 pg/ml [- 125.05, - 48.37], p < 0.00001). Combined narratively, 13 studies reported significantly lower concentrations of considered parameters in LS patients, whereas only one study reported lower inflammatory markers (for CRP and IL-6) after OS.
CONCLUSIONS: The increase in postoperative concentrations of several proinflammatory parameters was significantly less pronounced after LS than after OS in this meta-analysis. Overall, the summarized evidence reinforces the view of a lower induction of inflammation due to LS.