He Xiao-sheng, Wu Xiao-jian, Wang Jian-ping, Zou Yi-feng, Lan Ping
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Feb;13(2):119-24.
To evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer with meta-analysis.
Randomized controlled trial comparing D(2)/D(3) and D(2)/D(3) plus paraaortic lymphadenectomy in gastric cancer were identified by two investigators after search strategy was established. Seven randomized controlled trials with 1446 cases were included in this meta-analysis. Fixed effect model or random model was separately used to evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer.
Total complication rate in the D(2)/D(3) plus paraaortic lymphadenectomy group was significantly higher than that in the D(2)/D(3) group (RR 1.34, 95% CI 1.03-1.75, P=0.03), while surgery associated complication between the two groups was almost the same. Lymphorrhea and severe diarrhea was more common in the D(2)/D(3) plus paraaortic lymphadenectomy (RR 16.23 and 9.56, 95% CI 1.99-131.98 and 1.70-53.67, respectively). Anastomotic leak, pancreatic fistula, abdominal abscess, ileus, postoperative bleeding and wound infection were similar. There were no advantages in operating time, amount of blood transfusion, in-hospital stay, reoperation, recurrence and 5-year survival favoring the paraaortic lymphadenectomy group except intra-operative blood loss and rate of blood transfusion (WMD 202.95, 95% CI 116.80-289.10; RR 1.93, 95% CI 1.20-3.10).
Paraaortic lymphadenectomy is associated with increased total complication without altering postoperative recurrence and survival. Strict large-scale multicenter controlled trials with long-term follow-up are required.
通过Meta分析评估主动脉旁淋巴结清扫术治疗胃癌的安全性和有效性。
两名研究者在制定检索策略后，对比较胃癌D（2）/D（3）与D（2）/D（3）加主动脉旁淋巴结清扫术的随机对照试验进行了识别。本Meta分析纳入了7项随机对照试验，共1446例患者。分别采用固定效应模型或随机模型评估主动脉旁淋巴结清扫术治疗胃癌的安全性和有效性。
D（2）/D（3）加主动脉旁淋巴结清扫术组的总并发症发生率显著高于D（2）/D（3）组（RR 1.34，95%CI 1.03 - 1.75，P = 0.03），而两组手术相关并发症发生率几乎相同。D（2）/D（3）加主动脉旁淋巴结清扫术组乳糜漏和严重腹泻更为常见（RR分别为16.23和9.56，95%CI分别为1.99 - 131.98和1.70 - 53.67）。吻合口漏、胰瘘、腹腔脓肿、肠梗阻、术后出血和伤口感染情况相似。除术中失血量和输血率外，主动脉旁淋巴结清扫术组在手术时间、输血量、住院时间、再次手术、复发率和5年生存率方面并无优势（WMD 202.95，95%CI 116.80 - 289.10；RR 1.93，95%CI 1.20 - 3.10）。
主动脉旁淋巴结清扫术会增加总并发症发生率，但不会改变术后复发率和生存率。需要进行严格的大规模多中心长期随访对照试验。
