Department of Surgery, Westmead Hospital, PO Box 533, Wentworthville, NSW, 2145, Australia.
J Gastrointest Surg. 2014 Jun;18(6):1087-99. doi: 10.1007/s11605-014-2519-z. Epub 2014 Apr 17.
Laparoscopic distal gastrectomy has been increasingly utilized in the treatment of gastric adenocarcinoma. This study aims to compare the morbidity/mortality and postoperative outcomes of laparoscopic-assisted versus open distal gastrectomy since 2000.
A comprehensive search of MEDLINE and EMBASE was conducted including studies published between 2000 and present.
Seventeen studies with a total of 7,109 distal gastrectomies (3,496 lap vs 3,613 open) were included. Across all studies, postoperative morbidity rates for laparoscopic gastrectomy were lower than that of open [median (range) 10 (0-36) % vs 17 (0-43) %]. Meta-analysis of postoperative morbidity rates in prospective studies only yielded pooled odds ratio of 0.52 (95 % CI 0.33-0.81) (P = 0.004). In-hospital mortality rates were comparable between the two (range: laparoscopic 0-3.3 vs open 0-6.7 %). The long-term oncological outcomes of resection were difficult to analyze given variable reporting but appeared similar between the two. Meta-analysis of prospective studies showed that laparoscopic-assisted distal gastrectomy was associated with significantly shorter hospital length of stay [standard mean difference (SMD) = -0.78 (95 % CI = -1.0 to -0.56)], comparable intraoperative bleeding [SMD = 0.64 (95 % CI = -1.3-0.0430) P = 0.066] and longer operative time compared to open gastrectomy [1.9 (95 % CI 0.05-3.8) P = 0.045, with P < 0.001].
This study supports the use of laparoscopic-assisted distal gastrectomy for treatment of gastric adenocarcinoma with evidence of comparable, if not better, short-term postoperative parameters when compared to open distal gastrectomy. The long-term oncological outcomes appear similar but may require more evaluation.
腹腔镜辅助远端胃切除术已越来越多地应用于胃腺癌的治疗。本研究旨在比较 2000 年以来腹腔镜辅助与开放远端胃切除术的发病率/死亡率和术后结果。
对 MEDLINE 和 EMBASE 进行了全面检索，包括 2000 年至目前发表的研究。
共纳入 17 项研究，总计 7109 例远端胃切除术（3496 例腹腔镜 vs 3613 例开放）。所有研究中，腹腔镜胃切除术的术后发病率均低于开放手术[中位数（范围）10（0-36）% vs 17（0-43）%]。仅对前瞻性研究进行术后发病率的荟萃分析得出的合并优势比为 0.52（95%CI 0.33-0.81）（P=0.004）。两种手术的院内死亡率相当（腹腔镜 0-3.3% vs 开放 0-6.7%）。由于报告的结果存在差异，难以分析两种手术的长期肿瘤学结果，但似乎相似。对前瞻性研究的荟萃分析显示，腹腔镜辅助远端胃切除术与较短的住院时间相关[标准化均数差（SMD）=-0.78（95%CI=-1.0 至-0.56）]，术中出血量相当[SMD=0.64（95%CI=-1.3-0.0430）P=0.066]，与开放胃切除术相比，手术时间更长[1.9（95%CI 0.05-3.8）P=0.045，P<0.001]。
本研究支持将腹腔镜辅助远端胃切除术用于胃腺癌的治疗，与开放远端胃切除术相比，具有短期术后参数相似甚至更好的证据。长期肿瘤学结果似乎相似，但可能需要更多的评估。
