Laparoscopic Versus Open Surgery For Complete Mesocolic Excision With Colon Cancer: A Meta-analysis

Objective: To systematacially evaluate the feasibility and safety of laparoscopic complete mesocolic excision for patients with colon carcinoma.Methods: A search of CNKI, Wanfang database, VIP, CBM, Pub Med, EMbase, Web of Knowledge and The Cochrane Library was undertaken and studies published in the last eight years were identified. We included controlled clinical trials that addressed laparoscopic CME versus open CME for patients with colon cancer in our Meta-analysis. With strictly screening accordance to the inclusion and exclusion criteria,evaluating the quality of these experiments,effectual data were extracted from these studies and analyzed via the Review-Manager 5.3 software in the end.Results: A total of fifteen trials, involving a total of 1860 patients(including 954 patients in laparoscopic CME group and 906 patients in open CME group),were confirmed. Meta-analysis showed that:⑴ The amount of bleeding during operation in the laparoscopic CME group was smaller than open CME group[WMD=-23.09,95%CI(-36.87,-9.31), P=0.001]. There was no significant difference in the amount of operation time[WMD=4.67, 95%CI(-0.95,10.29),P=0.1] between laparoscopic CME group and open CME group;⑵ The significant differences lie in the time of liquid diet[WMD=-1.6,95%CI(-3.13,-0.07),P=0.04],postoperative indwelling drainage time[WMD=-1.84,95%CI(-2.4,-1.28),P<0.00001],the time of first flatus [WMD=-0.89,95% CI(-1.21,-0.57),P<0.00001],the time of off-bed activity [WMD=-0.78,95%CI(-0.95,-0.6), P< 0.00001] and the length of hospital stay[WMD=-2.82,95%CI(-3.73,-1.91),P<0.00001],in which the datas of the laparoscopic CME group were smaller than that of the open CME group;⑶The postoperative complication in the laparoscopic CME group was smaller than open CME group[OR=0.52,95%CI(0.36,0.76),P=0.0008]. There was no significant difference in the mortality[OR=0.44,95%CI(0.12,1.6),P=0.21] between laparoscopic CME group and open CME group;⑷ There were no significant differences in the number of lymph node[WMD=-0.6, 95%CI(-1.39,0.18),P=0.13],the length of large bowel resection[WMD=-1.38,95%CI(-4.05, 1.29),P=0.31] and the number of positive lymph node[WMD=0.19,95%CI(-0.49,0.88),P=0.58] between laparoscopic CME group and open CME group;⑸ There were no significant differences in the local recurrence rate[OR=0.83,95%CI(0.5,1.38),P=0.48],the distant metastasis rate [OR=1.2,95%CI(0.79,1.8),P=0.39], 5-year survival rate[OR=1.37,95%CI(0.68,2.78),P=0.38] and 5-year disease free survive[OR=1.29,95%CI(0.6,2.76),P=0.52] between laparoscopic CME group and open CME group.Conclusion: Laparoscopic CME is safe,effective and feasible.Compared with open CME,it can effectively cure colon cancer, reduce the incidence of postoperative complications, speed up the recovery and obtain a consistent long-term efficacy of open surgery.