Liang Yichao, Li Guoxin, Chen Pingyan, Yu Jiang, Zhang Ce
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
ANZ J Surg. 2011 Oct;81(10):673-80. doi: 10.1111/j.1445-2197.2010.05599.x.
We performed a meta-analysis in an attempt to answer whether short-term outcomes and lymph nodes harvested after laparoscopy-assisted gastrectomy (LAG) are comparable to those reported after conventional open gastrectomy (COG).
Prospective randomized clinical trials were eligible if they included patients with distal gastric cancer treated by LAG versus COG. End points were operating time, intra-operative blood loss, size of wound, overall post-operative complications, time to first flatus, time to start oral intake, hospital stay and lymph nodes harvested.
Six trials including 668 patients were included. For four of the 13 end points, the summary point estimates favoured LAG over COG; there was a significant reduction in intra-operative blood loss (weighted mean difference (WMD) −115.60, 95% confidence interval (CI) −159.16 to −72.04, P < 0.00001), size of wound (WMD −5.27, 95% CI −8.94 to −1.60, P= 0.005), overall post-operative complications (odds ratio 0.55, 95% CI 0.35 to 0.85, P = 0.008) and hospital stay (WMD −2.65, 95% CI −4.97 to −0.32, P= 0.03) for LAG. However, the combined results of the individual trials show significant longer operating time (WMD 112.98, 95% CI 60.32 to 165.64, P < 0.0001) and significant reduction in lymph nodes harvested (WMD −4.79, 95% CI −6.79 to −2.79, P < 0.00001) in the LAG group. There was no significant difference between the two groups in time to first flatus, time to start oral intake, wound infection, intra-abdominal fluid collection and abscess, anastomotic stenosis and leakage and pulmonary complications.
The results of this meta-analysis suggest that LAG for early distal cancer is a feasible and safe alternative to COG, with better short-term outcomes.
我们进行了一项荟萃分析，试图回答腹腔镜辅助胃癌切除术（LAG）后的短期结局和所获取的淋巴结数量是否与传统开放胃癌切除术（COG）报告的结果相当。
如果前瞻性随机临床试验纳入了接受LAG与COG治疗的远端胃癌患者，则该试验符合要求。终点指标包括手术时间、术中失血量、伤口大小、术后总体并发症、首次排气时间、开始经口进食时间、住院时间以及所获取的淋巴结数量。
纳入了6项试验，共668例患者。在13项终点指标中的4项上，汇总点估计显示LAG优于COG；LAG组术中失血量显著减少（加权平均差（WMD）−115.60，95%置信区间（CI）−159.16至−72.04，P<0.00001）、伤口大小减小（WMD −5.27，95%CI −8.94至−1.60，P = 0.005）、术后总体并发症减少（比值比0.55，95%CI 0.35至0.85，P = 0.008）以及住院时间缩短（WMD −2.65，95%CI −4.97至−0.32，P = 0.03）。然而，各试验的合并结果显示，LAG组手术时间显著延长（WMD 112.98，95%CI 60.32至165.64，P<0.0001），所获取的淋巴结数量显著减少（WMD −4.79，95%CI −6.79至−2.79，P<0.00001）。两组在首次排气时间、开始经口进食时间、伤口感染、腹腔内积液和脓肿、吻合口狭窄及漏出以及肺部并发症方面无显著差异。
这项荟萃分析的结果表明，对于早期远端癌症，LAG是一种可行且安全的替代COG的方法，具有更好的短期结局。
