gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2025-24-3-194-200gnck-2045Research ArticleМЕТААНАЛИЗMETA-ANALYSISПреимущества и недостатки лапароскопического доступа при экзентерациях органов малого таза у больных местнораспространенным раком прямой кишки (метаанализ и систематический обзор)Advantages and disadvantages of laparoscopic access for pelvic exenteration in patients with locally advanced rectal cancer (a meta-analysis and a systematic review)https://orcid.org/0000-0001-7342-5753БалкаровА. А.BalkarovA. A.

Балкаров Артем Анатольевич.

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

тел.: +7 (499) 199-00-68

Artyom A. Balkarov.

Salyama Adilya st., 2, 123423, Moscow

balkarov_aa@gnck.ruhttps://orcid.org/0000-0002-6212-9454ЧернышовС. В.ChernyshovS. V.

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

Stanislav V. Chernyshov.

Salyama Adilya st., 2, 123423, Moscow

https://orcid.org/0000-0002-3919-9067РыбаковЕ. Г.RybakovE. G.

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

Evgeny G. Rybakov.

Salyama Adilya st., 2, 123423, Moscow

https://orcid.org/0000-0003-1627-5394ЛихтерМ. С.LikhterM. S.

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

Mikhail S. Likhter.

Salyama Adilya st., 2, 123423, Moscow

https://orcid.org/0000-0002-8480-9362ШелыгинЮ. А.ShelyginYu. A.

ул. Саляма Адиля, д. 2, Москва, 123423; ул. Баррикадная, д. 2/1, Москва, 123995

Yuri A. Shelygin.

Salyama Adilya st., 2, 123423, Moscow; Barricadnaya st., 2/1, Moscow, 123995

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 Postgraduate EducationRussian Federation202516082025243194200Copyright © Балкаров А.А., Чернышов С.В., Рыбаков Е.Г., Лихтер М.С., Шелыгин Ю.А., 20252025Балкаров А.А., Чернышов С.В., Рыбаков Е.Г., Лихтер М.С., Шелыгин Ю.А.Balkarov A.A., Chernyshov S.V., Rybakov E.G., Likhter M.S., Shelygin Y.A.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/2045АКТУАЛЬНОСТЬ

АКТУАЛЬНОСТЬ: экзентерация органов малого таза — это хирургическая операция, выполняемая чаще всего при местраспространенном раке органов малого таза для достижения оптимальных границ резекции. Целесообразность выполнения таких операций лапароскопическим доступом носит спорный характер. Для оценки эффективности лапароскопических экзентераций органов малого таза, выполненных по поводу рака прямой кишки проведен метаанализ.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ: систематический обзор выполнен в соответствии с рекомендациями PRISMA. Поиск литературы выполнен в электронных базах медицинской литературы PubMed и eLibrary. Отобрано 4 ретроспективные сравнительные исследования, включающие результаты лечения 220 больных местнораспространенным раком прямой кишки, которым выполнялась лапароскопическая экзентерация и 311 больных, перенесших открытые вмешательства.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: получены статистически значимые различия в снижении интраоперационной кровопотери на 427 мл, 95% ДИ (p = 0,0004) и длительности пребывания в стационаре на 2 дня, 95% ДИ (p = 0,003) в группе лапароскопических операций. Сопоставимые данные получены по продолжительности операции (p = 0,45), частоте позитивного края резекции (ОШ = 0,85; 95% ДИ: 0,19–3,93; p = 0,84), общей частоте послеоперационных осложнений (ОШ = 0,62; 95% ДИ: 0,23–1,86; p = 0,34) и инфекций области хирургического вмешательства (ОШ = 0,56; 95% ДИ: 0,18–1,64; p = 0,29).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: лапароскопические экзентерации таза при местнораспространенном раке прямой кишки сопровождаются статистически значимо меньшей кровопотерей и послеоперационным койко-днем, при этом не отличаются от открытых вмешательств при сравнении других непосредственных результатов.

AIM

AIM: pelvic exenteration is a surgical procedure for locally advanced pelvic organ cancer in order to achieve optimal resection margins. The expediency of performing such operations with laparoscopic access is controversial. A meta-analysis was done to evaluate the effectiveness of laparoscopic pelvic exenterations for rectal cancer.

MATERIALS AND METHODS

MATERIALS AND METHODS: a systematic review was conducted in accordance with PRISMA practices and recommendations. Literature search was carried out in the electronic medical literature databases PubMed and eLibrary. According to a meta-analysis of 4 original studies, the results of treatment of 220 patients who underwent laparoscopic exenteration and 311 patients who underwent open surgery were evaluated.

RESULTS

RESULTS: significant differences were obtained in the reduction of intraoperative blood loss by 427 ml, 95% CI, p = 0.0004, and postoperative hospital stay by 2 days, 95% CI, p = 0.003 in the laparoscopic group. Comparable data were obtained for the operation time, p = 0.45, for the positive margin of resection (OR 0.85; 95% CI 0.19–3.93; p = 0.84), for the postoperative morbidity (OR 0.62; 95% CI 0.23–1.86; p = 0.34) and for surgical site infections (OR 0.56; 95% CI 0.18–1.64; p = 0.29).

CONCLUSION

CONCLUSION: laparoscopic exenterations are comparable in operation time to open procedure, reduce intraoperative blood loss and postoperative hospital stay days.

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