Паллиативные резекции толстой кишки при малосимптомной (бессимптомной) первичной опухоли и синхронных нерезектабельных метастазах колоректального рака в сравнении с системной химиотерапией (метаанализ)

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: 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: 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.

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