Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis.
Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis.
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DOI：
10.1007/s00464-016-4982-y
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发表时间：
2017-01
影响因子：
3.1
通讯作者：
Tuynman, Jurriaan
中科院分区：
文献类型：
--
作者：
van Oostendorp, Stefan;Elfrink, Arthur;Borstlap, Wernard;Schoonmade, Linda;Sietses, Colin;Meijerink, Jeroen;Tuynman, Jurriaan
关键词：
腹腔镜右半结肠切除术的结肠癌是与大量的发病率，尽管引进了增强恢复协议和腹腔镜手术。腹腔镜右半结肠切除术联合结肠内吻合术（IA）的创伤性小于腹腔镜辅助半结肠切除术，可能导致术后发病率进一步降低和恢复更快。目前的标准技术包括结肠游离的体外吻合术、肠系膜牵引和位于中/上腹部的拔牙伤口，与位于下腹部的拔牙伤口相比，术后发病率相对较高。对PubMed和Embase数据库中比较腹腔镜右半结肠切除术中肠内吻合与体外吻合的研究进行了系统性综述。主要结局为死亡率、短期发病率和住院时间。在质量评估方面，使用了MINORS核对表。使用随机效应模型进行荟萃分析，并对2012年≥发表的研究中有关短期发病率和住院时间的数据进行亚组分析。共识别出2692篇论文，分析中纳入了12项非随机对照研究，共计1492例患者。死亡率无显著变化（OR 0.36，95% CI 0.0 9 ~ 1.46; I2 = 0%）.短期发病率显著降低，有利于IA（OR 0.68，95%CI 0.49-0.93; I2 = 20%）。住院时间缩短，但存在严重异质性风险（MD −0.77天，95% CI −1.46至−0.07; I 2 = 81%）。对2012年≥发表论文的亚组分析显示，短期发病率下降幅度更大（OR 0.65，95% CI 0.50-0.85; I 2 = 0%），住院时间显著缩短，异质性风险较低（MD −0.77天，95% CI −1.17至−0.37; I 2 = 4%）。如本荟萃分析所示，腹腔镜右半结肠切除术中的结肠内吻合术与短期发病率降低和住院时间缩短相关，表明恢复更快。
Laparoscopic right hemicolectomy for colon cancer is associated with substantial morbidity despite the introduction of enhanced recovery protocols and laparoscopic surgery. Laparoscopic right hemicolectomy with an intracorporeal anastomosis (IA) is less invasive than laparoscopic assisted hemicolectomy, possibly leading to further decrease in post-operative morbidity and faster recovery. The current standard technique includes an extracorporeal anastomosis with mobilization of the colon, mesenteric traction and a extraction wound located in the mid/upper abdomen with relative more post-operative morbidity compared to extraction wounds located in the lower abdomen. A systematic review of PubMed and Embase databases was performed on studies comparing the intracorporeal versus the extracorporeal performed anastomosis in laparoscopic right hemicolectomy. Primary outcomes were mortality, short-term morbidity and length of stay. For quality assessment, the MINORS checklist was used. Meta-analysis was performed using a random-effects model, and a subgroup analysis was performed for data regarding short-term morbidity and length of stay in studies published in 2012≥. A total of 2692 papers were identified, 12 non-randomized comparative studies were included in the analysis with a total number of 1492 patients. No significant change in mortality was found (OR 0.36, 95 % CI 0.09–1.46; I 2 = 0 %). Short-term morbidity decreased significantly in favour of IA (OR 0.68, 95 % CI 0.49–0.93; I 2 = 20 %). Length of stay was decreased, but with serious risk of heterogeneity (MD −0.77 days, 95 % CI −1.46 to −0.07; I 2 = 81 %). Subgroup analysis for papers published in 2012≥ resulted in an even larger decrease in short-term morbidity (OR 0.65, 95 % CI 0.50–0.85; I 2 = 0 %) and a significant decrease in length of stay with low risk of heterogeneity (MD −0.77 days, 95 % CI −1.17 to −0.37; I 2 = 4 %). Intracorporeal anastomosis in laparoscopic right hemicolectomy is associated with reduced short-term morbidity and decreased length of hospital stay suggesting faster recovery as shown in this meta-analysis.
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DOI：
10.1007/s00464-009-0865-9
发表时间：
2010-08-01
影响因子：
3.1
作者：
Grams, Jayleen;Tong, Winnie;Salky, Barry
通讯作者：
Salky, Barry
DOI：
10.1007/s00464-014-3950-7
发表时间：
2015-08-01
影响因子：
3.1
作者：
Milone, Marco;Elmore, Ugo;Milone, Francesco
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Milone, Francesco
DOI：
10.1007/s00464-010-0902-8
发表时间：
2010-09-01
影响因子：
3.1
作者：
Fabozzi, Massimiliano;Allieta, Rosaldo;Nardi, Mario, Jr.
通讯作者：
Nardi, Mario, Jr.
影响因子：
1.9
作者：
Arredondo Chaves, Jorge;Pastor Idoate, Carlos;Hernandez Lizoain, Jose Luis
通讯作者：
Hernandez Lizoain, Jose Luis
DOI：
10.1089/lap.2012.0420
发表时间：
2013-05-01
影响因子：
1.3
作者：
Marchesi, Federico;Pinna, Ferdinando;Roncoroni, Luigi
通讯作者：
Roncoroni, Luigi