Objective: To systematically evaluate the safety and efficacy of laparoscopic versus open surgery for palliative resection of the primary tumor in stage IV colorectal cancer. Methods: The databases of CNKI, Wanfang, VIP, PubMed, EMBASE and Cochrane Library were searched to retrieve randomized controlled trials (RCT) or clinical controlled trials (CCT) comparing laparoscopic surgery with open surgery for palliative resection of the primary tumor in stage IV colorectal cancer published from January 1991 to May 2019. Chinese search terms included "colorectum/colon/rectum" , "cancer/malignant tumor" , "laparoscopy" , "metastasis" , " IV" ; English search terms included "laparoscop*" , "colo*" , "rect*" , "cancer/tumor/carcinoma/neoplasm" , " IV" , "metasta*" . Inclusion criteria: (1) RCT or CCT, with or without allocation concealment or blinding; (2) patients with stage IV colorectal cancer that was diagnosed preoperatively and would receive resection of the primary tumor; (3) the primary tumor that was palliatively resected by laparoscopic or open procedure. Exclusion criteria: (1) no valid data available in the literature; (2) single study sample size ≤20; (3) subjects with colorectal benign disease; (4) metastatic resection or lymph node dissection was performed intraoperatively in an attempt to perform radical surgery; (5) duplicate publication of the literature. Two researchers independently evaluated the quality of the included studies. In case of disagreement, the evaluation was performed by discussion or a third researcher was invited to participate. The data were extracted from the included studies, and the Cochrane Collaboration RevMan 5.1.0 version software was used for this meta-analysis. Results: Four CCTs with a total of 864 patients were included in this study, including 216 patients in the laparoscopic group and 648 patients in the open group. Compared with the open group, except for longer operation time (WMD=37.60, 95% CI: 26.11 to 49.08, P<0.05), laparoscopic group had less intraoperative blood loss (WMD=-74.89, 95% CI: -144.78 to -5.00, P<0.05), earlier first flatus and food intake after surgery (WMD=-1.00, 95% CI: -1.12 to -0.87, P<0.05; WMD=-1.61, 95%CI: -2.16 to -1.06, P<0.05), shorter hospital stay (WMD=-2.01, 95% CI: -2.21 to -1.80, P<0.05) and lower morbidity of postoperative complication (OR=0.52, 95% CI: 0.35 to 0.77, P<0.05). However, no significant differences were found in time to start postoperative chemotherapy, postoperative chemotherapy rate, and mortality (P > all 0.05). Conclusion: Laparoscopic surgery for palliative resection of the primary tumor is safe and feasible to enhance recovery after surgery by promoting postoperative bowel function recovery, shortening hospital stay and reducing postoperative complication in stage IV colorectal cancer.
目的： 系统评价腹腔镜比较开放手术姑息性切除Ⅳ期结直肠癌原发肿瘤的安全性和有效性。 方法： 计算机检索1991年1月至2019年5月中国知网、万方、维普、PubMed、EMbase、Cochrane Library数据库关于腹腔镜比较开放手术姑息性切除Ⅳ期结直肠癌原发肿瘤的随机对照试验（RCT）或临床对照试验（CCT），中文检索词包括"结直肠/结肠/直肠"、"癌/恶性肿瘤"、"腹腔镜"、"转移"、"Ⅳ期"；英文检索词包括"laparoscop*"、"colo*"、"rect*"、"cancer/tumor/carcinoma/neoplasm"、"Ⅳ"、"metasta*"。纳入标准：（1）RCT或CCT，无论是否进行分配隐藏或采用盲法；（2）术前诊断为Ⅳ期结直肠癌并拟行原发肿瘤切除术；（3）采用腹腔镜（腹腔镜组）和开放（开放组）手术进行结直肠癌原发肿瘤姑息性切除。排除标准：（1）文献未提供有效数据；（2）单个研究样本量≤20例；（3）研究对象为结直肠良性疾病；（4）术中行转移灶切除或淋巴结清扫等试图行根治性手术；（5）文献重复发表。两名研究者对纳入的文献质量进行独立评价；若有分歧，通过讨论或由第3名研究者参与评价。对符合标准的文献提取相关数据后采用RevMan5.1.0软件进行Meta分析。 结果： 4项CCT纳入本次研究，共有864例患者，其中腹腔镜组216例，开放组648例。纳入的4项研究文献质量等级中等偏下。Meta分析结果显示：除手术时间明显增加外（WMD=37.60，95% CI：26.11~49.08，P<0.001），腹腔镜组较开放组术中出血量明显减少（WMD=-74.89，95% CI：-144.78~-5.00，P=0.04），术后首次排气时间和进食时间均明显提前（WMD=-1.00，95% CI：-1.12~-0.87，P<0.001；WMD=-1.61，95% CI：-2.16~-1.06，P<0.001），住院时间明显缩短（WMD=-2.01，95% CI：-2.21~-1.80，P<0.001），术后并发症发生率明显降低（OR=0.52，95% CI：0.35~0.77，P=0.001）。但两组之间术后化疗开始时间、术后化疗率、病死率比较差异均无统计学意义（均P>0.05）。 结论： 腹腔镜姑息性切除Ⅳ期结直肠癌原发肿瘤能有效促进术后肠功能恢复，缩短住院时间，减少术后并发症，加速术后康复，具有一定的安全性和有效性。.
Keywords: Colorectal neoplasms; Laparoscopic surgery; Meta-analysis; Open surgery; Palliative resection.