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Does carbon dioxide pneumoperitoneum enhance wound metastases following laparoscopic abdominal tumor surgery? A meta-analysis of 20 randomized control studies

机译：腹腔镜腹部肿瘤手术后二氧化碳气腹会增强伤口转移吗？对20项随机对照研究的荟萃分析

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The mechanisms involved in the development of wound metastasis following laparoscopic abdominal tumor surgery remain unclear. The aim of this study was to accurately assess whether the duration of carbon dioxide pneumoperitoneum (CDP) during laparoscopic abdominal tumor surgery enhances wound metastases. We conducted a systematic review of PubMed, Cochrane Library, and Embase through December 2013 to identify animal experiments comparing wound recurrence between laparoscopic and gasless laparoscopic procedures or open procedures. The outcome of interest was the number of animals with a wound tumor. Meta-regression was used to assess whether heterogeneity was explained by study level covariates (animal model, study size, CDP pressure, duration, and evaluated time). Twenty randomized control studies involving 1,229 animals were included. Wound recurrence was not significant in the laparoscopic surgery (LP) vs. gasless laparoscopic surgery (GLP) subgroups [odds ratio (OR), 2.23; 95 % confidence interval (CI), 0.90–5.55; P = 0.08) or the LP vs. laparotomy (LA) subgroups (OR, 0.97; 95 % CI, 0.31–3.00; P = 0.08). Overall postoperative wound recurrence results were not significantly different between the study groups and controls (OR, 1.47; 95 % CI, 0.74–2.92; P = 0.28). A meta-regression analysis showed that the outcome was not correlated with the covariates (animal model: P = 0.82; evaluated time: P = 0.30; pressure of CDP: P = 0.12; duration time: P = 0.80). Current evidence suggests that CDP does not enhance wound metastases following laparoscopic abdominal tumor surgery. Additional large sample, well-designed, randomized, controlled trials are needed to further confirm whether CDP duration in laparoscopic abdominal tumor surgery significantly enhances wound recurrence.
机译：腹腔镜腹部肿瘤手术后伤口转移发展的机制尚不清楚。这项研究的目的是准确评估腹腔镜腹部肿瘤手术过程中二氧化碳气腹（CDP）的持续时间是否会增加伤口转移。我们在2013年12月之前对PubMed，Cochrane Library和Embase进行了系统评价，以鉴定比较腹腔镜和无气腹腔镜手术或开放手术之间伤口复发的动物实验。感兴趣的结果是有伤口肿瘤的动物数量。荟萃回归用于评估研究水平的协变量（动物模型，研究规模，CDP压力，持续时间和评估时间）是否解释了异质性。包括20项涉及1,229只动物的随机对照研究。腹腔镜手术（LP）与无气腹腔镜手术（GLP）亚组的伤口复发率不显着[比值比（OR），2.23； 95％置信区间（CI），0.90-5.55； P = 0.08）或LP与剖腹手术（LA）子组（OR，0.97; 95％CI，0.31-3.00; P = 0.08）。研究组和对照组之间的总体术后伤口复发结果无显着差异（OR，1.47； 95％CI，0.74-2.92； P = 0.28）。荟萃回归分析显示结果与协变量不相关（动物模型：P = 0.82；评估时间：P = 0.30； CDP压力：P = 0.12；持续时间：P = 0.80）。当前证据表明，腹腔镜腹部肿瘤手术后CDP不会增强伤口转移。需要进一步的大型样本，设计良好的随机对照试验，以进一步确认腹腔镜腹部肿瘤手术中CDP持续时间是否显着提高伤口复发率。

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