Оправданы ли паллиативные резекции ободочной и прямой кишки при малосимптомной первичной опухоли и синхронных нерезектабельных метастазах колоректального рака? (систематический обзор)

ЦЕЛЬ: определить, может ли паллиативная резекция (ПР) толстой кишки с последующим курсом химиотерапии улучшить общую выживаемость в сравнении с самостоятельной химиотерапией/лучевой терапией (ХТ/ЛТ) у малосимптомных пациентов с КРР и синхронными нерезектабельными метастазами.

МАТЕРИАЛЫ И МЕТОДЫ: систематический обзор, основанный на рекомендациях Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, проведен с использованием поисковых систем PubMed и Cochrane Database.

РЕЗУЛЬТАТЫ: было отобрано 18 нерандомизированных сравнительных исследований, в которых приняли участие 2995 пациентов (1734 ПР и 1261 ХТ/ЛТ). По возрасту, полу, соматическому статусу, локализации опухоли, распространенности метастатического процесса группы сравнения были сопоставимы в 12 исследованиях и неоднородны в 4 исследованиях. Медиана продолжительности жизни была сопоставима в обеих группах в 13 исследованиях (1460 пациентов: 787 ПР и 673 ХТ/ЛТ) и статистически значимо выше в группе ПР в 5 исследованиях (1535 пациентов: 947 ПР и 588 ХТ/ЛТ). В 17 исследованиях частота хирургических вмешательств на фоне осложнений в группах ПР и ХТ/ЛТ составила от 0% до 5.1% и от 4.4% до 48.1%, соответственно. В 17 исследованиях 30-дневная летальность в группах ПР и ХТ/ЛТ составила от 0% до 4.8% и от 0% до 14%, соответственно. В 1 исследовании в обеих группах наблюдалась высокая 30-дневная летальность (29.4% ПР и 19.3% ХТ/ЛТ, P < 0.05).

ВЫВОДЫ: вопрос, может ли паллиативная резекция ободочной или прямой кишки при малосимптомной первичной опухоли и нерезектабельных метастазах улучшить общую выживаемость больных, остается открытым. Однако, имеющиеся данные литературы говорят о том, что паллиативная резекция потенциально может улучшить канцероспецифическую выживаемость данной группы больных. Этот вывод основан на результатах нерандомизированных сравнительных исследованиях и данных досрочно завершенных РКИ, в связи с чем для окончательного вывода необходимы дальнейшие хорошо спланированные рандомизированные исследования.

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