gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2023-22-2-126-140gnck-1794Research ArticleОБЗОРЫ ЛИТЕРАТУРЫ И МЕТААНАЛИЗLITERATURE REVIEWS AND METAANALYSISПаллиативные резекции толстой кишки при малосимптомной (бессимптомной) первичной опухоли и синхронных нерезектабельных метастазах колоректального рака в сравнении с системной химиотерапией (метаанализ)Palliative primary tumor resection in minimally symptomatic (asymptomatic) patients with colorectal cancer and synchronous unresectable metastases versus chemotherapy alone: a metaanalysishttps://orcid.org/0000-0001-7245-4042АлимоваЮ. В.AlimovaIu. V.

Алимова Юлия Васильевна — аспирант, младший научный сотрудник

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Salyama Adilya st., 2, Moscow, 123423, Russia

doctoralimova@gmail.comhttps://orcid.org/0000-0002-8480-9362ШелыгинЮ. А.ShelyginYu. A.

Шелыгин Юрий Анатольевич — научный руководитель; доктор медицинских наук, профессор, академик РАН, заведующий кафедрой колопроктологии

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

ул. Баррикадная, д. 2/1, стр. 1, г. Москва, 125993, Россия

 

Salyama Adilya st., 2, Moscow, 123423, Russia

Barrikadnaya st., 2/1-1, Moscow, 125993, Russia

https://orcid.org/0000-0002-6963-2650РыбаковЕ. Г.RybakovE. G.

Рыбаков Евгений Геннадиевич — руководитель отдела онкопроктологии

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Salyama Adilya st., 2, Moscow, 123423, Russia

https://orcid.org/0000-0001-5655-6567АлексеевМ. В.AlekseevM. V.

Алексеев Михаил Владимирович — заведующий отделением онкопроктологии

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

ул. Баррикадная, д. 2/1, стр. 1, г. Москва, 125993, Россия

Salyama Adilya st., 2, Moscow, 123423, Russia

Barrikadnaya st., 2/1-1, Moscow, 125993, Russia

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian FederationФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава России; ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRyzhikh National Medical Research Center of Coloproctology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of RussiaRussian Federation202321062023222126140Copyright © Алимова Ю.В., Шелыгин Ю.А., Рыбаков Е.Г., Алексеев М.В., 20232023Алимова Ю.В., Шелыгин Ю.А., Рыбаков Е.Г., Алексеев М.В.Alimova I.V., Shelygin Y.A., Rybakov E.G., Alekseev M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1794ЦЕЛЬ

ЦЕЛЬ: оценить исходы лечения (общая выживаемость, частота хирургических вмешательств на фоне осложнений первичного лечения, 30-дневная летальность) при паллиативной резекции (ПР) толстой кишки с последующим курсом химиотерапии (ХТ) по сравнению с самостоятельной химиотерапией/лучевой терапией (ХТ/ЛТ) у пациентов с малосимптомной (бессимптомной) первичной опухолью и синхронными нерезектабельными метастазами при колоректальном раке (КРР).

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ: метаанализ, основанный на рекомендациях Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, проведен с использованием поисковых систем PubMed и Cochrane Database. Для исходов лечения рассчитывался показатель отношения шансов (ОШ) и 95% доверительный интервал (95% ДИ). Показатели ОШ оценивались по модели случайных эффектов. Статистическая обработка данных выполнялась в программе Review Manager, версия 5.3.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: было отобрано 18 нерандомизированных сравнительных исследований, в которых приняли участие 2999 пациентов (1737 ПР и 1262 ХТ/ЛТ). По возрасту, полу, локализации первичной опухоли и метастазов группы сравнения были сопоставимы во всех включенных исследованиях. Двухлетняя (38,2% против 21,1%; ОШ 0,42; 95% ДИ 0,28–0,64; p < 0,0001) и 5-летняя (12,7% против 5,3%; OШ 0,45; 95% ДИ 0,21–0,97; p = 0,04) общая выживаемость была статистически значимо выше в группе ПР по сравнению с группой ХТ/ ЛТ. Не было выявлено значительных различий между группами в 30-дневной летальности (1,7% против 1%; ОШ 1,92; 95% ДИ 0,79–4,68; p = 0,15). Однако частота хирургических вмешательств на фоне осложнений первичного лечения была значительно ниже в группе ПР (2,3% против 14,53%; ОШ 0,18; 95% ДИ 0,08–0,40; p < 0,0001). Кроме того, 114 пациентам в группе ХТ/ЛТ потребовалось хирургическое вмешательство из-за осложнений, возникших со стороны первичной опухоли (13,8%; ОШ 0,19; 95% ДИ 0,09–0,40; p < 0,0001). ВЫВОДЫ: ПР толстой кишки при малосимптомной (бессимптомной) первичной опухоли и нерезектабельных метастазах КРР значительно улучшает общую выживаемость больных и позволяет избежать хирургических вмешательств, связанных с осложнениями со стороны первичной опухоли. ПР не ассоциирована с высокой послеоперационной летальностью по сравнению с первичным лечением ХТ/ЛТ. Этот вывод основан на результатах нерандомизированных сравнительных исследований и данных досрочно завершенных рандомизированных контролируемых исследований (РКИ), поэтому для окончательного вывода необходимы дальнейшие хорошо спланированные рандомизированные исследования.

AIM

AIM: to evaluate outcomes (overall survival, rate of surgical intervention due to complications of first treatment, 30-day mortality rate) of palliative primary tumor resection (PTR) followed by chemotherapy and chemotherapy/ radiotherapy (chemo/RT) alone in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.

MATERIALS AND METHODS

MATERIALS AND METHODS: a meta-analysis based on Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted on PubMed and Cochrane database. Odds ratio (OR) and 95% confidence interval (95% CI) were used as the treatment effect measure for comparing results. Combined overall effect measures were calculated for a random effect model. All analyses were performed using the Review Manager 5.3 software.

RESULTS

RESULTS: eighteen non-randomized studies, including a total of 2,999 patients (1,737 PTR and 1,262 chemo/RT) were identified. Gender, age, site of primary tumor and distant metastasis of patients were comparable between groups in all analyzed studies. Two-year (38.2% vs. 21.1%; OR 0.42; 95% CI 0.28–0.64; p < 0.0001) and 5-year (12.7% vs. 5.3%; OR 0.45; 95% CI 0.21–0.97; p = 0.04) overall survival rates were significantly higher in the PTR group than in the chemo/RT group. No significant differences in 30-day mortality rate between the two groups (1.7% vs. 1%; OR 1.92; 95% CI 0.79–4.68; p = 0.15). However, the rate of surgical intervention due to complications of first treatment was significantly lower in the PTR group comparing to the chemo/RT group (2.3% vs. 14.53%; OR 0.18; 95% CI 0.08–0.40; p < 0.0001). At the same time, one hundred and fourteen patients (13.8%; OR 0.19; 95% CI 0.09–0.40; p < 0.0001) in the chemo/RT group required surgery for symptoms associated with a primary tumor.

CONCLUSIONS

CONCLUSIONS: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases significantly improves overall survival, allows to prevent surgical intervention due to complications related to primary tumor and is not associated with increased postoperative mortality rate comparing to systemic chemotherapy/radiotherapy as a treatment of first line. The current data are based on non-randomized comparative studies and data from early terminated randomized controlled trials (RCTs) and further well-designed RCTs are required.

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The authors declare that there are no conflicts of interest present.