| Objective:Totally laparoscopic right colectomy(TLRC)and laparoscopic assisted right colectomy(LARC)for right colon cancer were evaluated by means of meta-analysis to determine the safety and efficacy,providing a reference evidence-based evidence for the selection of two surgical methods for the treatment of right colon cancer.Methods:The relevant literature published from January 2000 to December 2018 was searched by public databases such as PubMed,Embase,the Cochrane Library,Web of Science,CNKI,China Biomedical Literature Service System(SinoMed),Wanfang,and so on.The comparative study of TLRC and LARC for right colon cancer was selected on the basis of the strictly established inclusion and exclusion criteria according to the search results.The relevant literature data was extracted after the evaluating of the obtained literature for quality by the modified Jadad scale and the Newcastle-Ottawa Scale(NOS).Finally,statistical analysis was performed by Revman5.3 software.Results;Twelve literatures meeting the requirements were included,one of which was a randomized controlled trial and 11 of which were non-randomized controlled trial.A total of 1429 patients,including 750 patients in the TLRC group and 679 patients in the LARC group.The meta analysis results showed that,the postoperative time to first flatus(WMD=-0.36?95%CI[-0.62,-0.09],P＝0.009),the postoperative time to first defecation(WMD=-0.74,95%CI[-1.05,-0.43],P<0.00001),postoperative hospital stay(WMD=-1.11,95%Cl[-1.78,-0.44],P＝0.001)were faster and length of the incision(SMD=-2.03,95%CI[-2.85,-1.20],P<0.00001)was shorter in TLRC group compared with the LARC group,which were statistically significant.And the incision infection(OR=0.36,95%Cl(0.22,0.61],p=0.0001)was rarer in the TLRC group than in the LARC group,but abdominal infection(OR=6.14,95%Cl(1.36,27.69],p=0.02)was more common,both of which had statistical significance.On the contrary,there were no statistically significant between TLRC group and LARC group in all below aspects,such as operation time(WMD=2.47,95%CI[-4.76,9.70],P＝0.50),intraoperative blood loss(WMD=-16.53,95%CI[-39.16,6.09],P＝0.15),conversion to laparotomy(OR=0.91,95%Cl[0.18,4.70],p=0.91),total postoperative complications(OR=0.61,95%Cl[0.37,1.02],P=0.06),reoperation intervention(OR=0.69,95%Cl[0.36,1.34],P=0.27),mortality(OR=0.52,95%CI[0.12,2.18],p=0.37),harvested lymph nodes(WMD=0.63,95%CI[-0.52,1.77],P=0.28)and other aspects.Conclusions:Better cosmetic results were achieved by the TLRC group than the LARC group and the postoperative recovery effect of the TLRC group was better without increasing the total postoperative complications.But a multicenter large randomized controlled trials are still needed to compare the short and long-term outcomes of two groups. |
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