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中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 466 -471. doi: 10.3877/cma.j.issn.1674-0793.2021.06.015

循证医学

同时性结直肠癌肝转移同期与分期手术疗效与安全性的Meta分析
马嘉阳1, 康大鹏1, 李文星1,()   
  1. 1. 030001 太原,山西医科大学第二医院普外科
  • 收稿日期:2021-06-28 出版日期:2021-12-01
  • 通信作者: 李文星

Efficacy and safety of simultaneous resection vs staged resection in the treatment of synchronous colorectal liver metastasis: A Meta-analysis

Jiayang Ma1, Dapeng Kang1, Wenxing Li1,()   

  1. 1. Department of General Surgery, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2021-06-28 Published:2021-12-01
  • Corresponding author: Wenxing Li
引用本文:

马嘉阳, 康大鹏, 李文星. 同时性结直肠癌肝转移同期与分期手术疗效与安全性的Meta分析[J]. 中华普通外科学文献(电子版), 2021, 15(06): 466-471.

Jiayang Ma, Dapeng Kang, Wenxing Li. Efficacy and safety of simultaneous resection vs staged resection in the treatment of synchronous colorectal liver metastasis: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 466-471.

目的

采用系统性评价的方法,对同时性结直肠癌肝转移(CRLM)行同期手术切除与分期手术切除的安全性和疗效进行评估。

方法

检索2011年1月至2021年4月在中国知网、万方数据、维普数据库、PubMed、Cochrane Library、Embase数据库中发表的有关比较同时性CRLM同期手术与分期手术疗效与安全性的相关文献。应用RevMan 5.3软件处理数据并进行荟萃分析。

结果

最终纳入18篇文献共3 937例患者,包括同期手术患者1 767例,分期手术患者2 170例。Meta分析显示,同期手术围手术期并发症发生率较分期手术更高(OR=1.23,95% CI:1.05~1.46,P=0.01),手术时间较短(WMD= -162.11,95% CI:-212.49~ -111.73,P<0.001),术后住院时间较少(WMD= -8.19,95% CI:-10.56~ -5.81,P<0.001)。而两种手术策略的患者围手术期死亡率、R0切除率、5年总生存率及术中出血量差异无统计学意义。

结论

对于同时性CRLM患者,施行同期手术目前可能有更高的并发症发生率,若患者存在耐受情况较差、原发灶肿瘤分期较晚、肝切除范围较大等可能加大手术难度的情况,采取分期手术仍是一种不错的治疗措施。

Objective

To evaluate the safety and efficacy of simultaneous resection compared with staged resection for synchronous colorectal liver metastases (CRLM) through the method of systematic evaluation.

Methods

A literature search was performed including PubMed, Cochrane Library, Embase, CNKI, Wanfang data and VIP databases from January 2011 to April 2021. The data were processed using RevMan 5.3 for Meta-analysis.

Results

A total of 3 937 patients were included in 18 articles, including 1 767 patients undergoing simultaneous resection and 2 170 patients undergoing staged resection. The incidence of perioperative complications in the simultaneous resection group was higher than staged operation group (OR=1.23, 95% CI: 1.05, 1.46, P=0.01), the operative time was shorter (WMD= -162.11, 95% CI: -212.49, -111.73, P<0.001), and the postoperative hospital stay was less (WMD= -8.19, 95% CI: -10.56, -5.81, P<0.001). There were no significant differences in perioperative mortality, R0 resection rate, 5-year overall survival rate or intraoperative blood loss.

Conclusion

For patients with synchronous CRLM, simultaneous resection may has a higher incidence of complications, and staged resection is still a good choice for patients with poor tolerance, late stage of the primary tumor, large range of liver resection and other conditions that may increase the difficulty of surgery.

表1 纳入文献基本信息
第一作者及年份 国家 病例来源年限 总例数 分组 例数 性别(例) 原发灶位置(例) 原发肿瘤分期(例) NOS评分
结肠 直肠 T1/T2 T3/T4
Abbott, 2012[25] 美国 1993—2010 144 S 60 40 20 26 34 8 50 9
        D 84 49 35 31 53 9 75  
胡俊杰, 2013[23] 中国 1999—2009 53 S 40 25 15 22 18 NA NA 8
        D 13 6 7 6 7 NA NA  
Mayo, 2013[24] 多国家 1982—2011 1 004 S 329 185 144 238 91 NA NA 8
        D 675 413 262 488 185 NA NA  
She, 2015[22] 中国 1990—2008 116 S 28 22 6 69 19 NA NA 9
        D 88 59 29 15 13 NA NA  
张远通, 2016[21] 中国 2008—2013 65 S 46 28 18 25 21 7 39 8
        D 19 9 10 9 10 3 16  
Silberhumer, 2016[20] 美国 1984—2008 429 S 320 170 150 177 143 51 269 7
        D 109 68 41 56 53 18 91  
Li, 2016[19] 中国 2009—2013 73 S 60 38 22 34 26 NA NA 7
        D 13 10 3 6 7 NA NA  
Fukami, 2016[18] 日本 2006—2013 63 S 41 18 23 25 16 NA NA 7
        D 22 12 10 10 12 NA NA  
Inoue, 2017[17] 日本 1995—2015 107 S 31 13 18 18 13 23 8 8
        D 76 43 33 41 34 53 23  
Nanji, 2017[16] 加拿大 1996—2009 226 S 100 124 102 NA NA 40 60 8
        D 126 54 46 NA NA 63 63  
Alexandrescu, 2017[15] 罗马尼亚 1995—2015 300 S 234 132 102 154 80 NA NA 6
        D 66 35 31 53 13 NA NA  
Le Souder, 2018[14] 加拿大 2005—2016 155 S 28 15 13 25 3 2 25 7
        D 127 73 54 91 36 6 121  
唐良振, 2020[13] 中国 2015—2017 76 S 45 24 21 23 22 NA NA 8
        D 31 17 14 16 15 NA NA  
Valdimarsson, 2020[10] 瑞典 2008—2015 537 S 160 90 70 125 35 NA NA 8
        D 377 234 143 262 115 NA NA  
Slupski, 2020[12] 波兰 1997—2012 131 S 52 35 17 32 20 9 43 8
        D 79 44 35 58 21 13 66  
Wang, 2020[11] 中国 2007—2016 233 S 86 45 41 62 24 NA NA 7
        D 147 98 49 85 62 NA NA  
Nitsche, 2020[9] 德国 2007—2016 140 S 68 38 30 40 28 NA NA 8
        D 72 48 24 40 32 NA NA  
Boudjema, 2021[26] 法国 2006—2015 85 S 39 25 14 27 12 NA NA -
        D 46 25 21 25 21 NA NA  
图1 文献筛选流程
图2 随机对照试验的偏倚风险图
图3 同期手术与分期手术治疗同时性结直肠癌肝转移患者的围手术期并发症发生率Meta分析结果
图4 同期手术与分期手术治疗同时性结直肠癌肝转移患者的围手术期死亡率Meta分析结果
图5 同期手术与分期手术治疗同时性结直肠癌肝转移患者的R0切除率Meta分析结果
图6 同期手术与分期手术治疗同时性结直肠癌肝转移患者的5年总生存率Meta分析结果
图7 同期手术与分期手术治疗同时性结直肠癌肝转移患者的漏斗图
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