背景:关于完整结肠系膜切除术(CME)对长期肿瘤结局的影响存在争议。这篇综述的目的是浓缩最新文献,并评估CME对癌症右结肠切除术后长期生存的影响。
方法:PubMed,MEDLINE,Scopus,和WebofScience在2023年7月进行了搜索。纳入的研究评估了CME对生存的影响。主要结果是长期总生存率。限制平均生存时间差(RMSTD),危险比(HR),和95%置信区间(CI)用作合并效应大小测量。使用等级方法来总结证据的确定性。
结果:共纳入10项研究(3665例患者)。总的来说,1443(39.4%)接受CME。RMSTD分析显示,在60个月的随访中,与无CME患者相比,I-III期CME患者的平均生存期为2.5个月(95%CI1.1-4.1).同样,在55个月随访时,接受CME的III期患者比noCME患者的寿命更长(6.1个月;95%CI3.4-8.5).CME与CME的时间依赖性HR分析noCME(I-III期疾病)在6个月时患有noCME的患者中显示出更高的死亡风险(HR0.46,95%CI0.29-0.71),12个月(HR0.57,95%CI0.43-0.73),24个月(HR0.73,95%CI0.57-0.92)至27个月。
结论:这项研究表明,在I-III期疾病中,CME与不明确的OS获益相关。建议谨慎,以避免高估CME在III期疾病中的作用,因为更长时间切除的边际益处可能受到肿瘤生物学/分子特征和多模式辅助治疗的影响。
BACKGROUND: Debate exists concerning the impact of complete mesocolic excision (CME) on long-term oncological outcomes. The aim of this review was to condense the updated literature and assess the effect of CME on long-term survival after right colectomy for cancer.
METHODS: PubMed, MEDLINE, Scopus, and Web of Science were searched through July 2023. The included studies evaluated the effect of CME on survival. The primary outcome was long-term overall survival. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. GRADE methodology was used to summarize the certainty of evidence.
RESULTS: Ten studies (3665 patients) were included. Overall, 1443 (39.4%) underwent CME. The RMSTD analysis shows that at 60-month follow-up, stage I-III CME patients lived 2.5 months (95% CI 1.1-4.1) more on average compared with noCME patients. Similarly, stage III patients that underwent CME lived longer compared to noCME patients at 55-month follow-up (6.1 months; 95% CI 3.4-8.5). The time-dependent HRs analysis for CME vs. noCME (stage I-III disease) shows a higher mortality hazard in patients with noCME at 6 months (HR 0.46, 95% CI 0.29-0.71), 12 months (HR 0.57, 95% CI 0.43-0.73), and 24 months (HR 0.73, 95% CI 0.57-0.92) up to 27 months.
CONCLUSIONS: This study suggests that CME is associated with unclear OS benefit in stage I-III disease. Caution is recommended to avoid overestimation of the effect of CME in stage III disease since the marginal benefit of a more extended resection may have been influenced by tumor biology/molecular profile and multimodal adjuvant treatments.