Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province 310016, China.
World J Surg Oncol. 2013 Aug 8;11:182. doi: 10.1186/1477-7819-11-182.
The use of laparoscopic gastrectomy (LG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. This study is a systematic review and meta-analysis of the available evidence.
A comprehensive search was performed until June 2013 to identify comparative studies evaluating survival rates, recurrence rates, surgical outcomes and complications. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using the random effects model. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.
Fifteen trials were involved in this analysis. Compared to open gastrectomy (OG), LG involved a longer operating time (WMD = 48.67 min, 95% CI 34.09 to 63.26, P < 0.001); less blood loss (WMD = -139.01 ml, 95% CI -174.57 to -103.44, P < 0.001); earlier time to flatus (WMD = -0.79 days, 95% CI -1.14 to -0.44, P < 0.001); shorter hospital stay (WMD = -3.11 days, 95% CI -4.13 to -2.09, P < 0.001); and a decrease in complications (RR = 0.74, 95% CI 0.61 to 0.90, P = 0.003). There was no significant difference in the number of harvested lymph nodes, margin distance, mortality, cancer recurrence rate and long-term survival rate between the AGC patients treated with LG or OG (P > 0.05).
Despite a longer operation, LG is a safe technical alternative to OG for AGC with a lower complication rate and enhanced postoperative recovery. Moreover, there were similar outcomes between both approaches in terms of cancer recurrence and the long-term survival rate. Because of the limitation of this study, methodologically high-quality studies are needed for further evaluation.
腹腔镜胃切除术（LG）在进展期胃癌（AGC）中的应用仍然存在争议，主要是因为对其肿瘤学疗效存在疑虑。本研究是对现有证据进行的系统评价和荟萃分析。
全面检索直至 2013 年 6 月的比较研究，以评估生存率、复发率、手术结果和并发症。使用随机效应模型计算汇总风险比（RR）和加权均数差（WMD）及其 95%置信区间（CI）。使用 RevMan 5.1 软件进行数据合成和统计分析。
共有 15 项试验纳入分析。与开腹胃切除术（OG）相比，LG 手术时间较长（WMD = 48.67 min，95%CI 34.09 至 63.26，P < 0.001），术中出血量较少（WMD = -139.01 ml，95%CI -174.57 至 -103.44，P < 0.001），术后肛门排气时间较早（WMD = -0.79 天，95%CI -1.14 至 -0.44，P < 0.001），住院时间较短（WMD = -3.11 天，95%CI -4.13 至 -2.09，P < 0.001），并发症发生率较低（RR = 0.74，95%CI 0.61 至 0.90，P = 0.003）。LG 组与 OG 组在淋巴结清扫数量、切缘距离、死亡率、癌症复发率和长期生存率方面无显著差异（P > 0.05）。
尽管 LG 手术时间较长，但对于 AGC 患者，LG 是一种安全的手术技术替代方法，其并发症发生率较低，术后恢复较快。此外，在癌症复发和长期生存率方面，两种方法的结果相似。由于本研究的局限性，需要进一步评估高质量的研究。
