| Objective: To evaluate the safety and feasibility of laparoscopic total mesocolectomy for colon cancer.Methods: Based on CNKI,wandang database,VIP database,PubMed,Embase and The Cochrane Library,The clinical control studies on laparoscopic total m esocolonectomy and open total mesocolonectomy for colon cancer patients publi shed in The past 10 years were searched by computer.Literature quality was e valuated and effective data were extracted,and Meta analysis was performed b y rev-man 5.3 software.Results:A total of thirteen trials,involving a total of 2638 patients(including 1348 patients in laparoscopic CME group and 1290 patients in open CME grou p),were confirmed.Meta-analysis showed that:(1)The amount of bleeding duri ng operation in the laparoscopic CME group was Smaller than open CME gro up[WMD=-37.02,95%CI(-51.28,-22.06),P<0.00001],The length of incision in lapa roscopic CME group was less than that in laparotomy group CME.[WMD=-14.85,95%CI(-21.33,-8.37),P<0.00001],There was no significant difference in the a mount of operation time[WMD=13.80,95%CI(4.81,22.78),P=0.003]between laparo scopic CME group and open CME group;(2)The significant differences lie in the time of postoperative indwelling drainage time[WMD=-1.71,95%CI(-2.11,-1.31),P<0.00001],the time of first flatus [WMD=-0.97,95% CI(-1.41,-0.53),P<0.00001],the time of off-bed activity [WMD=-1.35,95%CI(-3.01,-0.32),P= 0.11]and t he length of hospital stay[WMD=-3.72,95%CI(-4.91,-2.52),P<0.00001],in which t he datas of the laparoscopic CME group were smaller than that of the open C ME group;(3)The postoperative complication in the laparoscopic CME group was smaller than open CME group[OR=0.57,95%CI(0.44,0.74),P<0.00001].There was no significant difference in the mortality[OR=0.44,95%CI(0.14,1.27),P=0.16]between laparoscopic CME group and open CME group;(4)There were no si gnificant differences in the number of lymph node[WMD=-0.66,95%CI(-0.97,0.77),P=0.16],the length of large bowel resection[WMD=-2.33,95%CI(-5.47,0.82),P=0.15]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;(5)There wer e no significant differences in the local recurrence rate[OR=0.77,95%CI(0.47,1.27),P=0.31],the distant metastasis rate [OR=1.25,95%CI(0.84,1.87),P=0.28],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 surgery for colon cancer is safe,effective and fe asiblee. |
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