Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2019; 25(22): 2819-2832
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2819
Mini-invasive vs open resection of colorectal cancer and liver metastases: A meta-analysis
Shan-Ping Ye, Hua Qiu, Shi-Jun Liao, Jun-Hua Ai, Jun Shi
Shan-Ping Ye, Hua Qiu, Shi-Jun Liao, Jun-Hua Ai, Jun Shi, Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Ye SP and Shi J designed the study; Ye SP and Qiu H collected the literature and conducted the analysis of pooled data; Ye SP and Liao SJ helped to draft the manuscript; Ye SP and Ai JH wrote the manuscript; Ye SP and Shi J proofread and revised the manuscript; all authors have approved the version to be published.
Supported by: the National Natural Science Foundation of China, No. 81660487.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
PRISMA 2009 Checklist statement: This meta-analysis was prepared and revised in accordance with the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Shi, MD, Chief Doctor, Professor, Department of General Surgery, First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. shijunyfy@sina.com
Telephone: +86-791-88694893 Fax: +86-791-88694893
Received: February 28, 2019
Peer-review started: March 1, 2019
First decision: April 11, 2019
Revised: April 26, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: June 14, 2019
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer (CRC) is a common cause of cancer-related deaths, especially in cases with liver metastases. Simultaneous surgical resection of primary colorectal tumors and synchronous colorectal liver metastases (SCRLM) is an effective strategy to improve the overall survival rate. Application of minimally invasive surgery (MIS) is increasing, but the true benefits of MIS remain unclear.

Research motivation

We hope to offer guidance on the clinical care of MIS in CRC and SCRLM.

Research objectives

To help identify which optimal surgery method is suitable for patients with CRC and SCRLM.

Research methods

A systematic search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases for studies concerning minimally invasive and open surgery (OS) for the simultaneous resection of CRC and SCRLM. We followed the PRISMA agreement. The meta-analysis was performed using Review Manager Software, and the quality was assessed using the Newcastle-Ottawa scale.

Research results

Two hundred and sixteen patients in the mini-invasive group and 286 patients in the open group were included in this study. Intraoperative blood loss (P = 0.002) and blood transfusion (P = 0.03) were less, the recovery of intestinal function (P = 0.01) and diet (P < 0.0001) was faster, the length of postoperative hospital stay (P < 0.0001) was shorter, and the number of surgical complications was lower (P = 0.04) in the MIS group. However, the operation time, rates and severity of overall morbidity, as well as the rates of general morbidity showed no significant difference between the minimally invasive and OS groups. Moreover, the overall survival and disease-free survival after MIS were similar to those after OS.

Research conclusions

The current meta-analysis showed that MIS is an optimal strategy for the simultaneous resection of CRC and SCRLM.

Research perspectives

The results of the current meta-analysis may help researchers to develop guidelines about surgical methods in CRC and SCRLM more perfectly.