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Сравнение лапароскопических и открытых симультанных операций при синхронных метастазах колоректального рака в печени: метаанализ

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Цель. Анализ исследований, посвященных сравнению лапароскопических и открытых симультанных операций при синхронных метастазах колоректального рака в печени. Материал и методы. В электронных базах данных PubMed, Web of Science, Scopus, Embase, Cochrane Library до 20 октября 2020 г. проведен поиск исследований, посвященных сравнению открытых и лапароскопических симультанных операций при синхронном метастатическом поражении печени. Ключевые слова: simultaneous resections, colorectal cancer, liver metastases, simultaneous laparoscopic. Результаты. Метаанализ содержит результаты 1211 симультанных операций при синхронных метастазах колоректального рака в печени: 450 лапароскопических и 761 - открытых. Лапароскопические операции отличались меньшей кровопотерей (взвешенная разность средних (ВРС) = -131,77, 95% ДИ [-232,54; -31,00], р = 0,01), меньшей продолжительностью пребывания в стационаре после операции (ВРС = -2,87, 95% ДИ [-3,41; -2,33], р 0,00001), ранним первым актом дефекации (ВРС = -0,99, 95% ДИ [-1,40; -0,58], р 0,0001), ранним началом энтерального питания (ВРС = -1,20, 95% ДИ [-2,06; -0,33], р = 0,007]), меньшей частотой послеоперационных осложнений (ОШ = 0,60, 95% ДИ [0,46-0,80], р = 0,0004). Выявлено статистически значимое преимущество лапароскопического доступа в общей (ОР = 0,80, 95% ДИ 0,64-0,99, р = 0,04) и безрецидивной (ОР = 0,73, 95% ДИ [0,60-0,89], р = 0,002) выживаемости. Заключение. Периоперационные и отдаленные онкологические результаты свидетельствуют о безопасности и эффективности лапароскопических симультанных операций при синхронных метастазах колоректального рака по сравнению с открытыми вмешательствами.

Ключевые слова:
печень, колоректальный рак, синхронные метастазы, симультанные операции, лапароскопические операции, непосредственные результаты, отдаленные результаты, liver, colorectal cancer, synchronous metastases, simultaneous surgeries, laparoscopic interventions, immediate results, long-term results

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Comparison of laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver: meta-analysis

Aim. To analyze studies focused on comparing laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver. Materials and methods. The electronic databases PubMed, Web of Science, Scopus, Embase, Cochrane Library were searched for the studies focused on the comparison of open and laparoscopic simultaneous surgeries for synchronous metastatic liver lesions, dated till October 20, 2020. Keywords: simultaneous resections, colorectal cancer, liver metastases, simultaneous laparoscopic. Results. Meta-analysis contains the results of 1211 simultaneous surgeries for simultaneous metastases of colorectal cancer in the liver: 450 laparoscopic and 761 open surgeries. Laparoscopic surgery was characterized with lower blood loss [weighted mean difference (WMD) = -131.77, 95% CI: -232.54 to -31.00, p = 0.01], a shorter postoperative hospitalization [WMD = -2.87, 95% CI: -3.41 to -2. 33, p 0.00001], early first bowel movement [WMD = -0.99, 95% CI: -1.40 to -0.58, p 0.0001], early initiation of enteral feeding [WMD = -1.20, 95% CI: -2.06 to -0.33, p = 0.007]), lower incidence of postoperative complications [OR = 0.60, 95% CI: 0.46-0.80, p = 0.0004]. A statistically significant advantage of laparoscopic access was established in overall [OR = 0.80, 95% CI: 0.64-0.99, p = 0.04] and recurrence-free survival [OR = 0.73, 95% CI: 0.60-0.89, p = 0.002]. Conclusion. Perioperative and distant oncologic outcomes demonstrate safety and efficacy of laparoscopic simultaneous interventions for synchronous metastases of colorectal cancer in comparison with open interventions.

Keywords:
печень, колоректальный рак, синхронные метастазы, симультанные операции, лапароскопические операции, непосредственные результаты, отдаленные результаты, liver, colorectal cancer, synchronous metastases, simultaneous surgeries, laparoscopic interventions, immediate results, long-term results