Laparoscopic Left Colectomy Reduces Short-term Complications Results Of A Systematic Review And Meta-Analysis

Objective:The aim of the study was using the of method of meta-analysis to evaluate difference in short-term morbidity of laparoscopic left colectomy,compared with open surgery,to explore the advantages of laparoscopic left colectomy.Methods:A search of the electronic literature database Pubmed,OVID,Web of SCI,and the Cochrane library was performed for publications. The following search terms were used:“Colonic Neoplasms”“Colon Cancer”“left”“laparoscopy”“laparoscopic”“laparotomy”“open” “hemicolectomy”“hemicolectomy” “standard”“Colectomy”.Using the End Note X7.4 to manage the literature and find duplicates. According to the handbook of the Cochrane library to make the quality assessment for randomized controlled trails. And according to Newcastle-Ottawa scale to make the quality assessment for nonrandomized controlled trails. The primary endpoints were 30 days morbidity including : total complication,30 days mortality,anastomotic leakage,wound infections,pulmonary infections,urinary infections, intestinal obstruction. Secondary endpoints were procedural time, estimated blood loss, lymph nodes harvested, bowelmovement recovery,length of hospital stay. All statistical analyses were performed by Review-Manager5.3 and STATA12.0.Then,a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk(RR) was used as an indicator of treatment effect,if a RR less than 1.0 was in favour of laparoscopy. And mean differences(MD) also used as an indicator of treatment effect, if a MD less than 0.0 was in favour of laparoscopy. Publication bias was assessed by funnel plot, heterogeneity by the I2 test.Results:1. 942 primary literatures were searched, 243 coming from the Pubmed, 20 coming from the Ovid, 534 coming from the Web of SCI,45 coming from the Cochrane library. 13 of these studies were included finally, including 2 randomized controlled trails and 11 nonrandomized controlled trails.2. The publish time were between 2002 to 2014 of the including studies. The least of patients’ number was 32, the most of patients’ number was 303, and 1783 patients were included finally. The group of laparoscopy(LAP) include 908 patients, patients’ number between 9 to202. The group of open surgery(Open) include 965 patients, patients’ number between 16 to 181. And the age of patients between 24 to 85.3. 10 studies offered the information of the total complication,11 offerde the procedural time, 6 offered the estimated blood loss, 5offered the bowel movement recovery, 12 offered the length of hospital stay.4. The group of laparoscopy was superior to the group of open surgery in the primary endpoints. In secondary endpoints, the LAP spent much more time in the bowel movement recovery than the Open; the LAP spent less time in the procedural than the Open; and the LAP was less to the Open in the estimated blood loss and the length of hospital stay.And there was no difference between the LAP and the Open in the lymph nodes harvested.Conclusion:1. The LAP were superior to the Open in total complication, 30 days mortality, wound infections, pulmonary infections.2.There was no difference between the LAP and the Open in anastomotic leakage,urinary infections,intestinal obstruction. But there was a tendency that less occurred in the LAP.3. There was no difference between the LAP and the Open in the lymph nodes harvested.4. The LAP was better to the Open in the length of hospital stay and the bowel movement recovery.