[Laparoscopic-assisted resection for colorectal cancer without incision at abdomen versus traditional laparoscopic resection: A Meta-analysis].

ABSTRACT

OBJECTIVE: To evaluate the safety, feasibility and effectiveness of laparoscopic-assisted resection of colorectal cancer without incision at abdomen vs the traditional laparoscopic resection.
 Methods: We retrieved literature published from August, 2005 to August, 2015 to compare laparoscopic-assisted resection for colorectal cancer without incision at abdomen with the traditional laparoscopic resection. The clinical indicators were extracted from literature met inclusion criteria. The RevMan 5.3 software with a Meta-analysis was used.
 Results: Seven literature with a total of 621 patients, including 262 in laparoscopic-assisted resection of colorectal cancer without auxiliary incision at abdomen group (NOSE group) and 359 in conventional laparoscopic colorectal resection group (LAP group), were enrolled. The Meta-analysis showed that the total complication rate in the NOSE group was significantly less than that in the LAP group (OR=0.31, 95% CI 0.18 to 0.53, P<0.05). Complications of incision in the NOSE group were less than those in the LAP group (OR= 0.15, 95% CI 0.05 to 0.40, P=0.0002). Postoperative bleeding (OR=1.52, 95% CI 0.38 to 6.18, P=0.55), intestinal obstruction (OR= 0.30, 95% CI 0.09 to 0.98, P=0.05), anastomotic complications (OR=0.92, 95% CI 0.28 to 3.07, P=0.89), and other related complications (OR=0.63, 95% CI 0.23 to 1.66, P=0.35) showed no significant difference between the 2 groups (P>0.05). Hospitalization (MD=-0.66, 95% CI -1.33 to 0.01, P=0.05), duration of surgery (MD=14.78, 95% CI -1.75 to 31.31, P=0.08), bleeding amount (MD=-12.81, 95% CI -40.36 to 14.74, P=0.36), the tumor size (SMD=-0.40, 95% CI -0.87 to 0.08, P=0.10), the number of lymph node dissection (MD=-0.49, 95% CI 1.80 to 0.82, P=0.46), and the recurrence of 2-year follow-up (OR=1.15, 95% CI 0.38 to 3.50, P=0.81) were not statistically significant between the 2 groups. Time of gas passage (SMD=-0.62, 95% CI -0.82 to -0.42, P<0.001) and time of regular diet after surgery (SMD=-0.60, 95% CI -1.15 to 0.05, P=0.03) in the NOSE group were earlier than those in the LAP group. The postoperative pain score (MD=-1.49, 95% CI -1.97 to -1.01, P<0.001) in the NOSE group was significantly lower than that in the LAP group. Cosmetic surgery in the NOSE group had a higher index (MD=1.37, 95% CI 0.59 to 2.14, P=0.0005) compared with that in the LAP group.
 Conclusion: Laparoscopic-assisted resection for colorectal cancer without auxiliary incision at abdomen can obviously reduce the incidence of incision complications, and the patients can recover early and incision is showed more cosmetic. The method is safe, feasible, and effective.