| Background As one of the most common malignancies in China,colorectal cancer has drawn increasing attention due to its increasing incidence.At present,the therapeutic mode of colorectal cancer still revolves around surgery.Since 1991 Jacobs M et al first reported the use of laparoscopy in colon surgery,laparoscopic techniques have become more and more widely used in the field of colon surgery.As a result,a large number of clinical studies have emerged to assess the safety and superiority of laparoscopic surgery.However,there are no randomized controlled trials comparing open and laparoscopic surgery for transverse colon cancer so far.Many retrospective studies have also chosen to exclude transverse colon cancer,which may associate with the low incidence of transverse colon cancer,the difficulty and the risk of surgery.Objective The purpose of this study was to verify the safety and superiority of laparoscopic surgery for transverse colon cancer by comparing laparoscopic surgery with open surgery in terms of perioperative outcomes,surgical outcomes,and pathological outcomes.Methods1.A retrospective analysis was done on the clinical data of patients undergoing radical resection of transverse colon cancer from 2013 to 2017,including: age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)scores,underlying disease,previous abdominal surgery,tumor location,operative time,estimated blood loss,conversion,time to liquid diet,postoperative hospital stay,postoperative complications,reoperation,mortality,histologic type,tumor size,lymph nodes harvested,and TNM stage.2.Dichotomous variables were analyzed using chi-square test or Fisher’s exact probability method.Continuous variables were analyzed using the t-test.P<0.05 was considered statistically significant.Results1.A total of 47 patients who underwent radical resection of transverse colon cancer were enrolled.Of these,27(57.4%)had laparoscopic surgery and 20(42.6%)had laparotomy.2.There were no differences in age,gender,BMI,ASA scores,underlying disease,and previous abdominal surgery between the two groups.There was no significant difference in the distribution of tumor location between the two groups(P = 0.872).3.The mean operative time of laparoscopic surgery group was significantly longer than that of open surgery group(230.5min vs 162.5min,P < 0.001),while the estimated blood loss was significantly lower than that of open surgery group(90.1 ml vs 125.2 ml,P = 0.014).There was no conversion to laparotomy in the laparoscopic surgery group.4.The mean tumor size in the laparoscopic surgery group was smaller than that in the open group(4.4 cm vs 6.2 cm,P = 0.006).There was no significant difference in histologic type,number of lymph nodes harvested,and TNM stage between the two groups.5.The laparoscopic surgery group resumed liquid diet earlier than the open surgery group,with statistically significant difference(2.9 d vs 3.9 d,P = 0.002).6.Postoperative complications in the two groups,including wound infection,anastomotic leakage,ileus,and pneumonia,were not significantly different.One patient in the laparoscopic surgery group had concurrent pneumonia and ileus.There were no reoperation and mortality in both groups.7.The postoperative hospital stay was significantly shorter in the laparoscopic surgery group than in the open surgery group(8.4 d vs 12.1 d,P = 0.005).Conclusions1.Compared with open surgery,laparoscopic surgery for transverse colon cancer can bring short-term benefits to patients,such as: less intraoperative blood loss,faster diet recovery,and shorter hospital stay.2.At the same time,laparoscopic surgery was not significantly different from open surgery in terms of postoperative complications,reoperation,and mortality.Therefore,we believe that laparoscopic surgery is safe for transverse colon cancer.3.Large-scale,prospective,randomized controlled trials,particularly with long-term outcomes,are needed to further confirm the safety and superiority of laparoscopic surgery for transverse colon cancer.Background Meta-analysis is one of the best evidences in evidence-based medicine.It provides scientific evidence with more reference value by systematically combining and comprehensively analyzing the research results that extracted from multiple independent studies with the same topic.Worldwide,the incidence of colorectal cancer(CRC)is constantly rising,and so is our country.Surgical resection is still the core method of comprehensive treatment of CRC.However,due to the relatively low incidence of transverse colon cancer,complicated anatomy and high surgical skills required,the safety,superiority,and long-term efficacy of laparoscopic radical resection for transverse colon cancer remains insufficiently supported.Our previous retrospective study shown that laparoscopic surgery offers short-term benefits compared to open surgery,including fewer intraoperative blood loss,faster recovery,and shorter hospital stay,and found no significant differences in postoperative complications,reoperation,mortality between these two approaches.However,the previous study has the following limitation that it studied only a small sample size within one single-center and without long-term outcomes.Objective This study was undertaken to search for studies that compared laparoscopic surgery and open surgery for transverse colon cancer and to conduct meta-analysis of these studies to verify the safety,superiority and long-term effect of laparoscopic surgery.Methods1.The study was designed with reference to the PRISMA guidelines.2.We searched the Medline,Embase,Cochrane Library,Wanfang Data,and China National Knowledge Infrastructure(CNKI)for studies that compared laparoscopic surgery and open surgery for transverse colon cancer.The last literature search date was March 27,2018.3.The quality of the included studies was assessed according to the Cochrane Handbook and the Newcastle-Ottawa Scale(NOS).4.The primary outcomes included operative time,estimated blood loss,postoperative complications,perioperative mortality,overall survival,disease-free survival,local recurrence,and distant metastasis.5.Secondary outcomes included tumor size,number of lymph nodes harvested,proximal resection margin,distal resection margin,time to first flatus,time to liquid diet,postoperative stay,and length of hospital stay.6.We used the weighted mean difference(WMD)and 95% confidence interval(CI)to analyze the continuous variables,the Odds Ratio(OR)and 95% CI to analyze the dichotomous variables,the hazard ratios(HR)to analyze disease-free survival and overall survival.Inter-study heterogeneity was assessed using Chi2 and I2 tests.Publication bias was assessed by Egger’s test and funnel plots.The statistical software were Review Manager 5.3 and Stata/SE 12.0.Results1.A total of 16 retrospective studies fulfilled the inclusion and exclusion criteria,including 1881 patients--964 for laparoscopic surgery group and 917 for open surgery group.2.The quality of the included studies was moderate,with 8 studies gained 7 or higher points in NOS.3.There was no significant difference between laparoscopic surgery group and open surgery group in age,gender,BMI,and history of abdominal surgery.4.The laparoscopic surgery group had significantly longer operative time(WMD:39.27 min;95% CI,28.42 to 50.11;P < 0.00001),less estimated blood loss(WMD:-69.33 ml;95 % CI,-90.96 to-47.69;P < 0.00001),and smaller tumor size(WMD:-0.55 cm;95% CI,-0.83 to-0.27;P = 0.0001)than the open surgery group.5.There was no significant difference between these two approaches in number of lymph nodes harvested(WMD:-0.24;95% CI,-1.67 to 1.19;P = 0.74),proximal resection margin(WMD:-0.09 cm;95% CI,-0.98 to 0.81;P = 0.85),and distal resection margin(WMD: 0.28 cm;95% CI,-0.41 to 0.96;P = 0.43).6.The laparoscopic surgery group showed fewer postoperative complications than the open surgery group(OR: 0.66;95% CI,0.51 to 0.85;P = 0.001).There was no significant difference in wound infection(OR: 0.70;95% CI,0.41 to 1.20;P =0.19),anastomotic leakage(OR: 0.64;95% CI,0.34 to 1.22;P = 0.18),and ileus(OR: 0.92;95;% CI,0.51 to 1.67;P = 0.78).7.Patients in the laparoscopic surgery group had less time to first flatus(WMD:-1.01d;95% CI,-1.41 to-0.62;P < 0.00001)and resumed liquid diet earlier(WMD:-1.23d;95% CI,-1.52 to-0.94;P < 0.00001).8.The laparoscopic surgery group had shorter postoperative hospital stay(WMD:-2.39d;95% CI,-2.94 to-1.85;P < 0.00001)and total length of hospital stay(WMD:-4.31d;95% CI,-5.86 To-2.76;P < 0.00001).9.A total of 14 studies reported perioperative mortality and found no significant difference these two approaches(OR: 0.89;95% CI,0.22 to 3.60;P = 0.87).10.There was no significant difference in overall survival(HR: 0.91;95% CI,0.66 to1.24;P = 0.55),disease-free survival(HR: 0.86;95% CI,0.67 to 1.12;P = 0.27),local recurrence(OR: 1.27;95% CI,0.50 to 3.24;P = 0.62),and distant metastasis(OR: 0.65;95% CI,0.37 to 1.11;P = 0.12).11.Egger’s test and funnel plot revealed that there was no significant publication bias except wound infection and length of hospital stay.Conclusions1.Laparoscopic surgery for transverse colon cancer is safe and feasible.2.Laparoscopic surgery may bring short-term benefits to patients,including less intraoperative blood loss,earlier resumption of liquid diet,and less hospital stay.3.Laparoscopic surgery and open surgery were similar in perioperative complications,perioperative mortality,overall survival,disease-free survival,local recurrence,and distant metastasis.4.In the future,multi-center,well-designed randomized controlled studies with large-scale sample size,are needed to verify the findings of this study. |
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