A Meta-analysis Of The Effect Of Laparoscopic And Open Surgery For Obstructive Colorectal Cancer After Stent Placement

Objective : A meta-analysis was conducted to compare the short-term efficacy and postoperative complications of laparoscopic surgery and laparotomy in the treatment of obstructive colorectal cancer after self-expanding metal stent implantation.To evaluate the efficacy of laparoscopic surgery after self-expanding metal stents placement in the treatment of colorectal cancer complicated with cancer obstruction,and to provide a reference for clinical decision-making.Methods : Searched SCI,Springer Link,Pub Med,Ovid,CNKI,sinomed,VIP Chinese Journal Full-text Database,Wanfang database,the Cochrane Library and other data bases,and searched for the association of self expanding metal scaffolds(SEMS)published from January 1991 to December 2019 Laparoscopic surgery combined with self expanding metal stents(SEMS)and laparotomy for the treatment of obstructive colorectal cancer.Select the target literature strictly according to the standard,evaluate the quality of the literature,record the required data and use Revman 5.3 software for systematic analysis.Results:A total of 882 documents were retrieved from the above database,and 10 Chinese and English documents were included after screening.A total of 624 patients(299 in the stent combined with laparoscopy group,325 in the stent combined with laparotomy group)were included in the study.There was no significant difference in age and gender between the two groups.The results of meta-analysis showed that the bleeding volume of stent combined laparoscopic group was less than that of stent combined laparotomy group [WMD=-33.22,95%CI(-61.52,-4.92),P=0.02],the fistula rate of stent combined laparoscopic group was less than that of stent combined laparotomy group [OR=0.18,95%CI(0.04,0.82),P=0.03],but the operation time [WMD=25.37,95%CI(-1.23,51.98),P=0.06],and the number of lymph node dissection [WMD=1.71,95%CI(-2.95,6.38),P=0.47)and stent combined laparotomy group had no significant difference;the length of stay after stent combined laparoscopic surgery[WMD=-3.23,95% CI(-5.35,-1.11),P=0.003],the time of postoperative intestinal exhaust [WMD=-0.99,95%CI(-1.07,-0.92),P < 0.00001] were less than stent combined laparotomy group,and the time of postoperative food intake was significantly shorter in the group of combined stent and laparoscopy [WMD=-1.00,95%CI(-1.08,-0.92),P<0.00001];the total complications in the group of combined stent and laparoscopy were less than those in the group of combined stent and laparotomy [OR=0.38,95%CI(0.20,0.72),P=0.003],and the postoperative incision infection was less than those in the group of combined stent and laparoscopy[OR=0.43,95%CI(0.20,0.90),P=0.02],but stent combined laparoscopic group of pulmonary infection after surgery,postoperative inflammatory intestinal obstruction,anastomotic fistula,perioperative mortality associated with stent laparotomy group no significant statistical difference(P = 0.68,P= 0.28,P = 0.57,P= 0.62).Conclusions : Compared with the stent combined laparotomy group,the stent combined laparoscopy group had less intraoperative trauma,fewer postoperative complications and faster postoperative recovery in patients with colorectal cancer and cancerous obstruction.Laparoscopic surgery for colorectal cancer with cancerous obstruction after self-expanding metal stent implantation within a limited period is in line with the concept of minimally invasive treatment,and can effectively reduce postoperative complications,so it is recommended for clinical use.