Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2019; 25(22): 2819-2832
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2819
Mini-invasive vs open resection of colorectal cancer and liver metastases: A meta-analysis
Shan-Ping Ye, Hua Qiu, Shi-Jun Liao, Jun-Hua Ai, Jun Shi
Shan-Ping Ye, Hua Qiu, Shi-Jun Liao, Jun-Hua Ai, Jun Shi, Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Ye SP and Shi J designed the study; Ye SP and Qiu H collected the literature and conducted the analysis of pooled data; Ye SP and Liao SJ helped to draft the manuscript; Ye SP and Ai JH wrote the manuscript; Ye SP and Shi J proofread and revised the manuscript; all authors have approved the version to be published.
Supported by: the National Natural Science Foundation of China, No. 81660487.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
PRISMA 2009 Checklist statement: This meta-analysis was prepared and revised in accordance with the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Shi, MD, Chief Doctor, Professor, Department of General Surgery, First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. shijunyfy@sina.com
Telephone: +86-791-88694893 Fax: +86-791-88694893
Received: February 28, 2019
Peer-review started: March 1, 2019
First decision: April 11, 2019
Revised: April 26, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: June 14, 2019
Processing time: 106 Days and 21.7 Hours
Abstract
BACKGROUND

The safety and feasibility of the simultaneous resection of primary colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM) have been demonstrated in some studies. Combined resection is expected to be the optimal strategy for patients with CRC and SCRLM. However, traditional laparotomy is traumatic, and the treatment outcome of minimally invasive surgery (MIS) is still obscure.

AIM

To compare the treatment outcomes of MIS and open surgery (OS) for the simultaneous resection of CRC and SCRLM.

METHODS

A systematic search through December 22, 2018 was conducted in electronic databases (PubMed, EMBASE, Web of Science, and Cochrane Library). All studies comparing the clinical outcomes of MIS and OS for patients with CRC and SCRLM were included by eligibility criteria. The meta-analysis was performed using Review Manager Software. The quality of the pooled study was assessed using the Newcastle-Ottawa scale. The publication bias was evaluated by a funnel plot and the Begg’s and Egger’s tests. Fixed- and random-effects models were applied according to heterogeneity.

RESULTS

Ten retrospective cohort studies involving 502 patients (216 patients in the MIS group and 286 patients in the OS group) were included in this study. MIS was associated with less intraoperative blood loss [weighted mean difference (WMD) = -130.09, 95% confidence interval (CI): -210.95 to -49.23, P = 0.002] and blood transfusion [odds ratio (OR) = 0.53, 95%CI: 0.29 to 0.95, P = 0.03], faster recovery of intestinal function (WMD = -0.88 d, 95%CI: -1.58 to -0.19, P = 0.01) and diet (WMD = -1.54 d, 95%CI: -2.30 to -0.78, P < 0.0001), shorter length of postoperative hospital stay (WMD = -4.06 d, 95%CI: -5.95 to -2.18, P < 0.0001), and lower rates of surgical complications (OR = 0.60, 95%CI: 0.37 to 0.99, P = 0.04). However, the operation time, rates and severity of overall complications, and rates of general complications showed no significant differences between the MIS and OS groups. Moreover, the overall survival and disease-free survival after MIS were equivalent to those after OS.

CONCLUSION

Considering the studies included in this meta-analysis, MIS is a safe and effective alternative technique for the simultaneous resection of CRC and SCRLM. Compared with OS, MIS has less intraoperative blood loss and blood transfusion and quicker postoperative recovery. Furthermore, the two groups show equivalent long-term outcomes.

Keywords: Minimally invasive surgical procedures; Laparotomy; Colorectal neoplasms; Synchronous liver metastases; Meta-analysis

Core tip: For patients with colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM), there is no consensus regarding whether minimally invasive surgery (MIS) or open surgery (OS) is more beneficial. We conducted this meta-analysis to compare the treatment outcomes of MIS and OS for the simultaneous resection of CRC and SCRLM. We assessed the two methods in terms of short- and long-term outcomes. Compared with OS, MIS has less intraoperative blood loss and blood transfusion and quicker postoperative recovery. Furthermore, the two groups show equivalent long-term outcomes.