Meta-analysis Of The Safety And Long-term Outcomes Of Laparoscopic Versus Open Surgery For T₄ Colon Cancer

Objective:To evaluate short-term and oncological outcomes associated with laparoscopic versus conventional open surgery for T₄ colon cancer,and to provide evidence-based medical evidence for clinical diagnosis and treatment.Methods:The relevant literatures in CNKI,Wanfang,Pub Med,Embase and The Cochrane Library were searched,and then Review Manager 5.4 software was used for data analysis.Results:Finally,21 studies and 4705 patients were included,there were 2540 patients in the laparoscopic group and 2165 patients in the open group.Meta-analysis showed that compared with the open group,the laparoscopic group had less intraoperative blood loss（WMD=-62.15,95%CI=-76.64～-47.66,P<0.00001）,shorter postoperative hospital stay（WMD=-2.66,95%CI=-3.65～-1.67,P<0.00001）,and a lower incidence of complications within 30 d after surgery（OR=0.52,95%CI=0.41～0.67,P<0.00001）.However,the operative time was longer（WMD=17.88,95%CI=5.73～30.02,P=0.004）.There were no significant differences in R0 resection rate（OR=1.31,95%CI=0.91～1.88,P=0.15）,number of dissected lymph nodes（OR=-0.83,95%CI=-2.37～0.72,P=0.29）and local recurrence rate（OR=1.25,95%CI=0.62～2.53,P=0.53）between the two groups.For long-term postoperative effect,5-year disease-free survival rate was higher in the laparoscopic group（OR=1.32,95%CI=1.04～1.67,P=0.02）,but there was no significant difference in 3-year overall survival rate（OR=1.24,95%CI=0.93～1.66,P=0.14）,3-year disease-free survival rate（OR=1.14,95%CI=0.86～1.53,P=0.36）,5-year overall survival rate（OR=1.20,95%CI=0.97～1.48,P=0.10）between the two groups.Conclusion:For the treatment of T₄ colon cancer,laparoscopic surgery has the advantages of less intraoperative blood loss,shorter postoperative hospital stay,and lower incidence of complications within 30 days after surgery.Laparoscopic surgery does not adversely affect R0 resection rate,number of lymph nodes,local recurrence rate and long-term survival rates.