Network Meta-analysis Of The Short-term Outcomes Of Different Right Hemicolectomies For Right Colon Cancer

Objective:Based on the existence of a variety of right hemicolectomy,the existing research reports are mostly about the comparison of the short term outcomes of the new surgical procedure with the conventional laparoscopic,and there are little directed comparisons of themselves.By reviewing of the literatures,we have not yet found a meta-analysis or systematic review about different surgical procedures for right hemicolectomy.It is not possible to make an overall assessment to all surgical procedures.Therefore,there are no objective systematical reviews for these procedures and most of surgeons make the surgery arrangement plan by their own experience instead of evidence-based medicine.In this study,Network Meta-analysis was used to compare the short-term outcomes of different surgical procedures for right colon cancer in order to evaluate the advantages and disadvantages of these different right hemicolectomies with objective and quantifiable evidence-based medical evidence and to describe and rank them with frequency probability.Method:A comprehensive literature research of the PubMed,Embase,Medline,the Cochrane Central Library,Wan Fang and China National Knowledge Infrastructure(CNKI)databases was performed from 1991.01 to 2018.01.Original articles comparing different surgical approaches of laparoscopic right colon resection for patients with neoplastic diseases were included.According to the established inclusion and exclusion criteria,the data of the selected documents were extracted to evaluate the literature quality.The Network Meta-analysis was performed with software such as STATA 14.1,R,and GeMTC.The odds ratio(OR),mean difference(MD),and 95%confidence interval were used as effect indicators.Results:34 clinical comparative articles with a total of 4794 patients in Chinese and English(24 in English,10 in Chinese)were included,including 6 RCTs and 28 NRCTs.Patients included in the study were comparable in terms of general information such as age,gender,BMI and so on.The forest maps and ranked probability plots of NMA(in descending order)showed that:There was no statistically significant difference in the number of lymph node dissections for each surgical procedure.NOSE-TA and NOSE-TV were compared to gold standard surgical procedure LARH.The operative time was longer and the difference was statistically significant with a MD of 93(95%CI:33,1.5e+ 2)and a MD of 46(95%CI:8.6,84),and the operation time of ORH was significantly shorter than that of LARH with a MD of-45(95%CI:-67.-24).The rank probability of all surgical operations was NOSE-TA>NOSE-TV>TLC>LARH>SILARH>HAL>ORH.The blood loss of ORH was significantly more than LARH with a MD of 74(95%CI:28,12e + 2),the difference of the rest of the surgery was not statistically significant.The order of rank probability of blood loss during surgery was ORH>NOSE-TV>HAL>TLC>LARH>SILARH>NOSE-TA.The time to first flatus of TLC was shorter than LAHR and the difference was statistically significant with a MD of-0.65(95%CI:-1.1,-0.21).The ranked probability results of time to first flatus are ORH>LARH>HAL>SILARH>NOSE-TV>TLC>NOSE-TA.The length of the hospital stay of TLC and SILARH was significantly shorter than LAHR with a MD of-1.2(95%CI:-2,-0.36)and-1.1(-2,-0.27)and the length of the hospital stay of ORH was significantly longer than LAHR with a MD of 1.6(95%CI:0.5,2.8).The rank probability of length of hospital day for all surgical postoperative was:ORH>HAL>NOSE-TA>LARH>NOSE-TV>SILARH>TLC.The incidence of operative complications after ORH operation was significantly higher than LARH with a MD of 2.2(95%CI1,2,4-).The postoperative complications of the other surgery compared to LARH are not significant difference.The order of ranking of all the surgical complications was NOSE-TA>ORH>NOSE-TV>HAL>LARH>SILARH>TLC.Conclusions:According to the results of the Network meta-analysis of our study,there are no significant differences in the number of lymph node dissections from the different types of right colon cancer radical resection.All of these are in line with the principle of radical tumors.The total laparoscopic technique represented by NOSE-TV,NOSE-TA,and TLC has obvious advantages in the early recovery of postoperative intestinal function,but NOST-TA and NOSE-TV also have longer operation time caused by the learning curve.On the contrary,traditional abdominal incision surgery represented by ORH and HAL has advantages such as shorter operative time,higher postoperative complications,higher blood loss,and later postoperative recovery of bowel function.The laparoscopic combined laparotomy techniques represented by LAHR and SILARH have shown that short-term outcomes such as operative time,blood loss,time to first flatus,and postoperative complications rate range between total laparoscopic and traditional open surgery.