Short term benefits for laparoscopic colorectal resection

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Abstract
Colorectal resections are common surgical procedures all over the world. Laparoscopic colorectal surgery is technically feasible in a considerable amount of patients under elective conditions. Several short‐term benefits of the laparoscopic approach to colorectal resection (less pain, less morbidity, improved reconvalescence and better quality of life) have been proposed. This review compares laparoscopic and conventional colorectal resection with regards to possible benefits of the laparoscopic method in the short‐term postoperative period (up to 3 months post surgery). We searched MEDLINE, EMBASE, CancerLit, and the Cochrane Central Register of Controlled Trials for the years 1991 to 2004. We also handsearched the following journals from 1991 to 2004: British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt für Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie. Handsearch of abstracts from the following society meetings from 1991 to 2004: American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons. All randomised‐controlled trial were included regardless of the language of publication. No‐ or pseudorandomised trials as well as studies that followed patient's preferences towards one of the two interventions were excluded, but listed separately. RCT presented as only an abstract were excluded. Results were extracted from papers by three observers independently on a predefined data sheet. Disagreements were solved by discussion. 'REVMAN 4.2' was used for statistical analysis. Mean differences (95% confidence intervals) were used for analysing continuous variables. If studies reported medians and ranges instead of means and standard deviations, we assumed the difference of medians to be equal to the difference of means. If no measure of dispersion was given, we tried to obtain these data from the authors or estimated SD as the mean or median. Data were pooled and rate differences as well as weighted mean differences with their 95% confidence intervals were calculated using random effects models. 25 RCT were included and analysed. Methodological quality of most of these trials was only moderate and perioperative treatment was very traditional in most studies. Operative time was longer in laparscopic surgery, but intraoperative blood was less than in conventional surgery. Intensity of postoperative pain and duration of postoperative ileus was shorter after laparoscopic colorectal resection and pulmonary function was improved after a laparoscopic approach. Total morbidity and local (surgical) morbidity was decreased in the laparoscopic groups. General morbidity and mortality was not different between both groups. Until the 30th postoperative day, quality of life was better in laparoscopic patients. Postoperative hospital stay was less in laparoscopic patients. Under traditional perioperative treatment, lapararoscopic colonic resections show clinically relevant advantages in selected patients. If the long‐term oncological results of laparoscopic and conventional resection of colonic carcinoma show equivalent results, the laparoscopic approach should be preferred in patients suitable for this approach to colectomy. 腹腔鏡結腸直腸切除術的短期好處 結腸直腸切除術是全世界普遍的外科手術。在相當數量的患者選擇下,腹腔鏡結腸直腸手術在技術上是可行的。腹腔鏡結腸直腸手術的幾個短期的好處(較不疼痛、較少併發症、較短的恢復期、較好的生活品質) 這是回顧比較腹腔鏡結腸直腸手術和常規結腸直腸切除術,關於腹腔鏡結腸直腸手術短期手術後期間的可能的好處(手術後3個月) 從1991年到2004年我們搜尋了MEDLINE， EMBASE， CancerLit，以及Cochrane.我們也搜尋了從1991年到2004年的學報：如 British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt f?r Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie 從1991年到2004年的American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons.會議摘又要搜尋: 所有不管任何語言出版物的randomisedcontrolled trial. Noor pseudorandomised試驗研究,隨著病人的喜好對其中兩個,排除干預但是單獨列出.隨機對照試驗,只是摘要,則被排除 結果由三個獨立的調查員從一張預定義的資料表中提出來,由討論解決了分岐.統計分析使用了, REVMAN4.2,平均差異(95%置信區間)被用在連續分析變量.如果研究報告中位數和範圍，代替了平均數和標準差, 我們假定中位差異等於平均差異,假如沒有測變異度,我們試圖從作者或估計的統計為平均或中位數獲得這些數據.數據的匯集和速率的差異，以及不同的加權平均95％的可信區間計算運用隨機效應模型 25個隨機受控試驗被包括及分析.大多的方法學質量這些試驗只是適度的手術治療期間大多數研究是非常傳統的,在腹腔鏡手術,手術時間較長但術中出血低於常規手術.腹腔鏡結直腸切除術後疼痛強度和術後腸阻塞持續時間短，腹腔鏡結直腸切除後肺功能得到改善....