Сравнение лапароскопических и открытых симультанных операций при синхронных метастазах колоректального рака в печени: метаанализ

Цель. Анализ исследований, посвященных сравнению лапароскопических и открытых симультанных операций при синхронных метастазах колоректального рака в печени.
Материал и методы. В электронных базах данных PubMed, Web of Science, Scopus, Embase, Cochrane Library до 20 октября 2020 г. проведен поиск исследований, посвященных сравнению открытых и лапароскопических симультанных операций при синхронном метастатическом поражении печени. Ключевые слова: simultaneous resections, colorectal cancer, liver metastases, simultaneous laparoscopic.
Результаты. Метаанализ содержит результаты 1211 симультанных операций при синхронных метастазах колоректального рака в печени: 450 лапароскопических и 761 – открытых. Лапароскопические операции отличались меньшей кровопотерей (взвешенная разность средних (ВРС) = –131,77, 95% ДИ [–232,54; –31,00], р = 0,01), меньшей продолжительностью пребывания в стационаре после операции (ВРС = –2,87, 95% ДИ [–3,41; –2,33], р < 0,00001), ранним первым актом дефекации (ВРС = –0,99, 95% ДИ [–1,40; –0,58], р < 0,0001), ранним началом энтерального питания (ВРС = –1,20, 95% ДИ [–2,06; –0,33], р = 0,007]), меньшей частотой послеоперационных осложнений (ОШ = 0,60, 95% ДИ [0,46–0,80], р = 0,0004). Выявлено статистически значимое преимущество лапароскопического доступа в общей (ОР = 0,80, 95% ДИ 0,64–0,99, р = 0,04) и безрецидивной (ОР = 0,73, 95% ДИ [0,60–0,89], р = 0,002) выживаемости.
Заключение. Периоперационные и отдаленные онкологические результаты свидетельствуют о безопасности и эффективности лапароскопических симультанных операций при синхронных метастазах колоректального рака по сравнению с открытыми вмешательствами.

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