Short term benefits for laparoscopic colorectal resection

 

Abstract

Background

Colorectal resections are common surgical procedures all over the world. Laparoscopic colorectal surgery is technically feasible in a considerable amount of patients under elective conditions. Several short-term benefits of the laparoscopic approach to colorectal resection (less pain, less morbidity, improved reconvalescence and better quality of life) have been proposed.

Objectives

This review compares laparoscopic and conventional colorectal resection with regards to possible benefits of the laparoscopic method in the short-term postoperative period (up to 3 months post surgery).

Search methods

We searched MEDLINE, EMBASE, CancerLit, and the Cochrane Central Register of Controlled Trials for the years 1991 to 2004.
We also handsearched the following journals from 1991 to 2004: British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt für Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie. Handsearch of abstracts from the following society meetings from 1991 to 2004: American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons.

Selection criteria

All randomised-controlled trial were included regardless of the language of publication. No- or pseudorandomised trials as well as studies that followed patient's preferences towards one of the two interventions were excluded, but listed separately. RCT presented as only an abstract were excluded.

Data collection and analysis

Results were extracted from papers by three observers independently on a predefined data sheet. Disagreements were solved by discussion. 'REVMAN 4.2' was used for statistical analysis. Mean differences (95% confidence intervals) were used for analysing continuous variables. If studies reported medians and ranges instead of means and standard deviations, we assumed the difference of medians to be equal to the difference of means. If no measure of dispersion was given, we tried to obtain these data from the authors or estimated SD as the mean or median. Data were pooled and rate differences as well as weighted mean differences with their 95% confidence intervals were calculated using random effects models.

Main results

25 RCT were included and analysed. Methodological quality of most of these trials was only moderate and perioperative treatment was very traditional in most studies. Operative time was longer in laparscopic surgery, but intraoperative blood was less than in conventional surgery. Intensity of postoperative pain and duration of postoperative ileus was shorter after laparoscopic colorectal resection and pulmonary function was improved after a laparoscopic approach. Total morbidity and local (surgical) morbidity was decreased in the laparoscopic groups. General morbidity and mortality was not different between both groups. Until the 30th postoperative day, quality of life was better in laparoscopic patients. Postoperative hospital stay was less in laparoscopic patients.

Authors' conclusions

Under traditional perioperative treatment, lapararoscopic colonic resections show clinically relevant advantages in selected patients. If the long-term oncological results of laparoscopic and conventional resection of colonic carcinoma show equivalent results, the laparoscopic approach should be preferred in patients suitable for this approach to colectomy.

 

Plain language summary

Short-term benefits for laparoscopic colorectal resection

Colorectal cancer is one of the most common cancers in industrialised countries, in both female and male persons. Treatment involves surgical removal (resection) of the segment of the bowel containing the tumor and wide tumorfree margins. Lymph nodes in the area are also removed (lymphadendectomy). conventional surgery which is the mainstream treatment of colorectal cancer and has good survival rates for stage-1 tumors. Other diseases that can require removal of sections of the large bowel include inflammatory diseases such as diverticulitis, Crohn's disease, ulcerative colitis, familial adenomatous polyposis (FAP) and rectal prolapse.
The conventional approach to surgery involves making a cut through the abdominal wall. For many people it is now possible to use video-endoscopic surgery (laparoscopy), which may have short term advantages that include less pain, better pulmonary function, shorter time for return of bowel function (duration of postoperative ileus), less fatigue, better quality of life and improved convalescence. However, the procedure is complex and for colorectal cancer the oncological long-term results on survival not known.
The review authors identified 25 controlled trials in which 3526 men and women were randomized to one surgical technique or the other. Colorectal resection was most often required for colorectal carcinoma. Overall, laparoscopic colon resections showed advantages over conventional surgery. Blood loss was a little less (by 113 to 31 ml, mean 72 ml); pain, which was treated with epidural or patient-controlled on demand analgesia, was less intense; time to return of bowel function was less, by about one day; lung function was improved with reduced postoperative stay in hospital (by 1.4 days) and improved quality of life in the first 30 days. The operation time was longer with laparoscopic surgery than with conventional surgery (by 42 minutes, range 30 to 55 minutes). Re-operation was not more likely after laparoscopic surgery and general complications in the lungs, heart, urinary tract or deep vein thrombosis (DVT) were similar with the two surgery techniques. Wound infections were less in laparoscopic patients. Some patients are not suitable for laparoscopy.

 

摘要

背景

腹腔鏡結腸直腸切除術的短期好處

結腸直腸切除術是全世界普遍的外科手術。在相當數量的患者選擇下,腹腔鏡結腸直腸手術在技術上是可行的。腹腔鏡結腸直腸手術的幾個短期的好處(較不疼痛、較少併發症、較短的恢復期、較好的生活品質)

目標

這是回顧比較腹腔鏡結腸直腸手術和常規結腸直腸切除術,關於腹腔鏡結腸直腸手術短期手術後期間的可能的好處(手術後3個月)

搜尋策略

從1991年到2004年我們搜尋了MEDLINE， EMBASE， CancerLit，以及Cochrane.我們也搜尋了從1991年到2004年的學報：如 British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt f?r Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie 從1991年到2004年的American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons.會議摘又要搜尋:

選擇標準

所有不管任何語言出版物的randomisedcontrolled trial. Noor pseudorandomised試驗研究,隨著病人的喜好對其中兩個,排除干預但是單獨列出.隨機對照試驗,只是摘要,則被排除

資料收集與分析

結果由三個獨立的調查員從一張預定義的資料表中提出來,由討論解決了分岐.統計分析使用了, REVMAN4.2,平均差異(95%置信區間)被用在連續分析變量.如果研究報告中位數和範圍，代替了平均數和標準差, 我們假定中位差異等於平均差異,假如沒有測變異度,我們試圖從作者或估計的統計為平均或中位數獲得這些數據.數據的匯集和速率的差異，以及不同的加權平均95％的可信區間計算運用隨機效應模型

主要結論

25個隨機受控試驗被包括及分析.大多的方法學質量這些試驗只是適度的手術治療期間大多數研究是非常傳統的,在腹腔鏡手術,手術時間較長但術中出血低於常規手術.腹腔鏡結直腸切除術後疼痛強度和術後腸阻塞持續時間短，腹腔鏡結直腸切除後肺功能得到改善. 在腹腔鏡這個群組,總併發症和局部(外科)併發症下降，在兩個群組間一般併發症和死亡率並沒有不同.直到術後第30天,腹腔鏡患者的生活品質較好.腹腔鏡患者術後住院時間也較減少

作者結論

在傳統手術治療之下，選擇腹腔鏡大腸切除術患者臨床顯示相對的好處。如果大腸癌常規切除術和腹腔鏡手術在腫瘤方面的長期結果相同，對結腸切除術,腹腔鏡的方法患者應該會更喜歡.

翻譯人

本摘要由國泰綜合醫院張世昌翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

腹腔鏡結腸直腸切除術的短期好處. 直腸結腸癌在工業國家的男性和女性來說是很普遍的. 侵入性治療外科移除(切除)腸段包括腫瘤以及較寬的無腫瘤邊緣.區域淋巴結也要移除.(lymphadendectomy). 這是結直腸癌主流治療的常規手術,對於第一期的腫瘤有很好的存活率.包括發炎性疾病的一些其他疾病也能切除部分大腸.像是Crohn disease, ulcerative colitis, familial adenomatous polyposis (FAP) and rectal prolapse. 對於現在使用腹腔鏡的人來說,做一個外科的小切口通過腹壁,是常規的方法.它可以有一些短期的好處,包括疼痛減少,肺功能較好,腸道功能恢復時間短(術後腸阻塞),減少疲勞,較好的生活品質.無論如何做法是複雜的,對於直結腸癌的長期存活是不知的. 回顧作者定義了隨機的3526名男性和女性外科手術或其他,25次的受控試驗. 對於直結腸癌,直結腸的切除手術經常是必須的,整體來說，腹腔鏡結腸直腸切除術的好處勝過常規手術.血液流失只有少許.(31到113毫升,平均72毫升).較少有疼痛控制的需求,腸道功能恢復的時間較短,大約一天.肺功能改善減少術後住院時間(1.4天)大大改善前30天的生活品質.腹腔鏡手術與傳統手術相比時間長(約42分,30分到55分之間). 腹腔鏡手術後,再度手術較少,肺部一般性合併症,心臟合併症,泌尿道合併症,深部靜脈栓塞,兩個手術方式類似. 腹腔鏡手術患者的傷口感染較少,不過仍然有些患者不適合腹腔鏡手術