Background: Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparospopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes. Methods: Medline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated. Results: Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR)=0.83 (0.56, 1.22); P=0.34], disease free survival (p=0.20), local recurrence (p=0.81) or distant metastases (p=0.24). LPA was found to have longer operative time [Weighted mean difference (WMD)=45.00 (29.48, 60.52);P<0.00001] with earlier establishment of oral intake [WMD=-1.68 (-1.84, -1.53);P<0.00001] and shorter hospital stay [WMD =-2.94 (-4.27, -1.62);P=0.0001]. No difference was found in relation to anastomotic leakage (p=0.39), intra-abdominal abscess (p=0.25), lymph nodes harvested (p=0.17). Conclusions: LPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer.
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机译：背景：所有将腹腔镜与开放性鞘膜切除术进行比较的随机对照试验均已排除了横结肠恶性肿瘤，这可能是由于在中腹绞痛血管周围进行解剖需要先进的腹腔镜技术及相关的发病率。有人担心，剖腹手术可能会损害横结肠癌的肿瘤清除率。本研究旨在通过对长期和短期结果进行荟萃分析，全面比较腹腔镜（LPA）与开放（OPA）方法。方法：询问Medline，Embase，Cochrane库，Scopus和Web of Knowledge数据库。对选定的研究进行严格评估，并对近期发病率和长期肿瘤学结局进行荟萃分析。根据研究质量，手术类型（腹腔镜与腹腔镜辅助）以及淋巴结清扫术的水平进行敏感性分析。统计异质性和出版偏见也进行了调查。结果：这项研究包括11例病例对照试验（1415例患者）。 LPA和OPA的总生存率无差异[危险比（HR）= 0.83（0.56，1.22）； P = 0.34]，无病生存期（p = 0.20），局部复发（p = 0.81）或远处转移（p = 0.24）。发现LPA的手术时间更长[加权平均差异（WMD）= 45.00（29.48，60.52）; P <0.00001]，且口服摄入量较早[WMD = -1.68（-1.84，-1.53）; P <0.00001]住院时间短[WMD = -2.94（-4.27，-1.62）; P = 0.0001]。吻合口漏（p = 0.39），腹腔内脓肿（p = 0.25），淋巴结清扫（p = 0.17）没有发现差异。结论：LPA的肿瘤学结局与OPA相当，在某些患者人群中具有更好的短期结局，似乎是安全的。需要高质量的随机对照试验来进一步研究腹腔镜检查在横结肠癌中的作用。
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