|Year : 2014 | Volume
| Issue : 6 | Page : 42-44
Risk of postoperative deep venous thrombosis in patients with colorectal cancer treated with open or laparoscopic colorectal surgery: A meta-analysis
YZ Xie, K Fang Fang, WL Ma, ZH Shi, XQ Ren
Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng 457000, China
|Date of Web Publication||24-Feb-2015|
Dr. X Q Ren
Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng 457000
Source of Support: None, Conflict of Interest: None
Introduction: Whether the incidence rate of deep venous thrombosis (DVT) between laparoscopic and open colorectal cancer surgery the same or not were under the debated without conclusion. The aim of this study was to compare the incidence of DVT after laparoscopic or open colorectal cancer surgery by meta-analysis. Materials and Methods: The open published articles comparing the incidence of DVT after laparoscopic or open colorectal cancer were collected in the data bases of Medline, the Cochrane central register of controlled trials and CNKI. The relative risk (RR) was pooled by using random or fixed effect mode to evaluate the incidence of DVT between laparoscopic or open colorectal cancer surgery.Results: After searching the databases, 9 randomized clinical studies with 2606 colorectal cancer cases were included in this meta-analysis. The mean operation time was 201.8 ± 17.28 min with its range of 180.0-224.4 min in the laparoscopic surgery group and 148.1 ± 18.8 min with its range of 135.0-184.0 min in the open surgery group. The operation time for laparoscopic surgery group were significant lower than in the open surgery group (P < 0.05). The RR of DVT between the laparoscopy and open surgery groups was 0.71 with its 95% confidence interval of 0.35-1.45 (P = 0.35). Conclusions: The operation time in laparoscopic colorectal cancer surgery was statistical longer than in the open colorectal cancer surgery, but the DVT risk of the two surgery approach was not different according to this meta-analysis.
Keywords: Colorectal cancer, deep venous thrombosis, laparoscopic colorectal surgery, meta-analysis, mini invasive
|How to cite this article:|
Xie Y Z, Fang K F, Ma W L, Shi Z H, Ren X Q. Risk of postoperative deep venous thrombosis in patients with colorectal cancer treated with open or laparoscopic colorectal surgery: A meta-analysis. Indian J Cancer 2014;51, Suppl S2:42-4
|How to cite this URL:|
Xie Y Z, Fang K F, Ma W L, Shi Z H, Ren X Q. Risk of postoperative deep venous thrombosis in patients with colorectal cancer treated with open or laparoscopic colorectal surgery: A meta-analysis. Indian J Cancer [serial online] 2014 [cited 2021 Dec 1];51, Suppl S2:42-4. Available from: https://www.indianjcancer.com/text.asp?2014/51/6/42/151992
Y Z Xie FNx01, K Fang FNx01
FNx01Drs. Xie YZ and Fang K contributed equally to the study
| » Introduction|| |
Laparoscopic colorectal surgery is an option surgery procedure in management of colorectal cancer.  The present data indicated that the laparoscopic procedure was associated with modest survival advantage, significantly faster recovery and shorter hospital stays compared with open approach.  The NCCN guideline for colorectal cancer treatment recommends that laparoscopic-assisted colorectal surgery be considered by surgeons experienced in the technique. The advantages for laparoscopic-assisted colorectal surgery compared to conventional open approach for the overall survival, disease free survival and other short period outcomes.  But whether the risk of deep venous thrombosis (DVT) between laparoscopic and conventional open colorectal cancer surgery the same or not were under the debated without conclusion.
| » Materials and Methods|| |
Publication search strategy
The randomized controlled trials (RCTs) comparing risk of postoperative DVT in patients with colorectal cancer treated with open or laparoscopic colorectal surgery were search across an electronic sensitive search of Medline, the Cochrane central register of controlled trials and CNKI databases. The search terms were used ([Rect-OR Col-OR Bowel OR Intestin-] AND [neoplasm-OR Tumo-OR Mass OR Cancer OR Carcino-OR Adenocarcinoma OR Malignan-]) AND ([Surg-OR Laparo-OR Video Assisted Surg-OR Opereat-OR Resector Hemicolectomy OR Subtotal OR Colect-OR Anterior OR Abdominoperineal OR Panprocto-OR Minimal]). Searches were limited to human trials, with the language restriction of English and Chinese. All references of relevant articles were scanned for additional analysis.
Inclusion and exclusion criteria
The inclusion criteria were: (1) The study design was prospective RCTs; (2) the patients was pathology confirmed of colorectal carcinoma; (3) the patients were treated by open or laparoscopic colorectal surgery; (4) the outcome should include the incidence rate of DVT in each group. The exclusion were: (1) Overlapping study populations; (2) retrospectively studies or case reports; (3) patients other than colorectal cancer; (4) not enough data for evaluation the DVT risk in each study; (5) published language other than English or Chinese.
The data of each included trails were extracted by two reviewers (YZX and KF) independently and consulted for the third reviewer (XQR) when encountering the controversy. The follow information and data of the included studies were extracted from the full text paper: (1) First author of each article; (2) journal of the publication paper; (3) year of publication; (4) region of the trails done; (5) mean age of the include patients for each trial; (6) the location of the cancer; (7) the mean operation time in the laparoscopic and open group.
The Stata 11.0 (Stata Corporation, College Station, TX, USA, http://www.stata.com/) software were used for data analysis. The risk of DVT between laparoscopic and open colorectal surgery were assessed by relative risk (RR). The heterogeneity among the included studies was evaluated by Chi-square and I2 . If I2 > 50% or P < 0.05 for heterogeneity test, the randomized effect method was used to pool the RR. Otherwise, the fixed effect method was used. Two tails P < 0.05 was deemed as statistical significance.
| » Results|| |
General characteristics of included studies
According to the inclusion and exclusion criteria, 9 randomized clinical trials were included in this meta-analysis. The publication year ranged from 2000 to 2009. And the number of cases included in each study ranged from 34 to 794. Of the included 9 studies, 2 trails included the patients with colon cancer, 2 studies included the patients with rectal cancer and other 5 included the patients with colorectal carcinoma. 6 studies reported the clinical stage by Duke method 2 by AJCC and 1 by UICC. The detailed information of included 9 trails was showed in [Table 1].
The mean operation time was 201.8 ± 17.28 min with its range of 180.0-224.4 min in the laparoscopic surgery group and 148.1 ± 18.8 min with its range of 135.0-184.0 min in the open surgery group. The operation time for laparoscopic surgery group were significant lower than in the open surgery group (P < 0.05). The distribution of operation time for each included study is shown in [Figure 1].
Risk of postoperative deep venous thrombosis
The median DVT rate was 0.4% and 2.0% in the laparoscopy and open surgery groups with their ranges of 0-1.5% and 0-6.3% respectively [Table 2]. We further pooled the RR of DVT between the laparoscopy and open surgery groups by fixed effect model (I2 = 0.0%, P = 0.57). The pooled RR was 0.71 with its 95%CI of 0.35-1.45 (P = 0.35). The pooled results indicated that no statistical difference of DVT risk was found between laparoscopy and open surgery groups [Figure 2].
|Figure 2: The forest plot for evaluation the risk of deep venous thrombosis between laparoscopic and open surgery groups|
Click here to view
The publication bias was evaluated by begg's funnel plot and Egger's line regression analysis [Figure 3]. The cycles representing each of the included studies were symmetrical distribution in the begg's funnel plot and Egger's line regression analysis indicated that the t = −0.03 and the P = 0.99 for publications. Both the begg's funnel plot and Egger's line regression indicated no significant publications were existed in this meta-analysis.
| » Discussion|| |
Deep venous thrombosis is a major public health challenge, representing a significant clinical and economic disease burden on healthcare systems.  In the UK alone, approximately 59,000 new cases of DVT arise per year.  Up to 21% of DVT may lead to pulmonary embolism, a potentially life-threatening complication. And DVT is one of the most diagnosed complications in patients who treated by surgery. The incidence rate of DVT in colorectal cancer patients treated by operation range from 37% to 46%, respectively.  And with the development of surgery technique and instrument, the laparoscopic-assisted colorectal surgery was performed more and more extensive in the treatment of colorectal cancer with the advantages of overall survival, disease free survival faster recovery and shorter hospital stays.  However, the laparoscopic-assisted colorectal surgery also has its disadvantages such as relative long operation time and long training period for surgeon.  And some doctors believe that the relative longer operation time, intraoperative aeroperitoneum and Trendelenburg operative body position increased the risk of developing DVT in patients treated with laparoscopic-assisted colorectal surgery. But other researchers believe that the aparoscopic-assisted colorectal surgery had mini invasive procedure which has less intention to the blood coagulation system compared with conventional open. This may made laparoscopic-assisted colorectal surgery less risk for postoperative DVT in patients with colorectal carcinoma. Leung et al. published their RCTs about aparoscopic assisted colorectal surgery versus conventional open resection colorectal tumor.  In their study, 203 patients received laparoscopic assisted surgery, and 200 cases received conventional open surgery. In aparoscopic assisted group, no postoperative DVT was observed and in conventional open group, 4 case of postoperative DVT was found. The risk of postoperative DVT was lower in the laparoscopic assisted surgery compared to conventional open surgery. But Neudecker's et al. study, the postoperative DVT risk was not different between laparoscopic-assisted surgery and conventional open surgery. 
In our meta-analysis, we found that the operation time in laparoscopic colorectal cancer surgery was statistical longer than in the open colorectal cancer surgery, but the DVT risk of the two surgery approach was not different. But with small number of included studies and small number cases included in each study, the conclusion should be further proofed by well-designed prospective RCTs comparing the postoperative DVT risk between laparoscopic assisted surgery and conventional open surgery.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]