Medial approach versus lateral approach in laparoscopic colorectal resection：a meta-analysis
10.3760/cma.j.issn.1671-0274.2014.05.018
- VernacularTitle:中间入路与侧方入路腹腔镜结直肠切除术比较的Meta分析
- Author:
Jie DING
1
;
Guoqing LIAO
;
Zhongmin ZHANG
;
Yang PAN
;
Kaisheng XU
;
Shaoyong WANG
;
Dongmiao LI
;
Zhongshu YAN
Author Information
1. 贵州省人民医院胃肠外科
- Keywords:
Laparoscopic;
Colorectal resection;
Medial approach;
Lateral approach;
Colorectal disease;
Meta-analysis
- From:
Chinese Journal of Gastrointestinal Surgery
2014;(5):480-485
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the safety and efficacy of the medial approach (MA) and the lateral approach (LA) in the treatment of colorectal disease. Methods Studies published from January 1994 to April 2013 that compared MA to LA in laparoscopic colorectal resection were collected. Publications in English were mainly identified from Medline, Embase, Cochrane Library, and those in Chinese from Wanfang database and CNKI database. Conversion rate, operative time, blood loss, number of harvested lymph nodes, hospital stay, complication, mortality, recurrence, and hospitalization costs of MA and LA were meta-analyzed using fixed-effect and random-effect models. Results Five cohort studies (2 randomized controlled trials and 3 retrospective studies) including 881 patients were enrolled and analyzed. Of these patients, 416 and 465 underwent laparoscopic colorectal resection with MA and LA respectively. As compared to LA, MA had significantly lower conversion rate (OR=0.42, 95%CI:0.25-0.72,P=0.001), shorter operative time(WMD=-52.62, 95%CI:-63.23--42.01, P<0.01), less number of harvested lymph nodes (WMD=-1.17, 95%CI:-1.89--0.45, P=0.001), while blood loss was less and hospitalization cost lower. Significant differences in intraoperative complications and postoperative complications were not found between the two group (OR:0.57, 95%CI:0.15-2.18, P=0.41;OR:0.78, 95%CI:0.52-1.17, P=0.23). Conclusions Compared with LA, MA has the advantages of shorter operative time and lower conversion rate with similar safety. Differences in blood loss, hospitalization cost and oncological safety between the two approaches warrant further investigation.
