Maret-Ouda John, Konings Peter, Lagergren Jesper, Brusselaers Nele
*Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden †Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.
Ann Surg. 2016 Feb;263(2):251-7. doi: 10.1097/SLA.0000000000001438.
To investigate the preventive effect of antireflux surgery against esophageal adenocarcinoma (EAC) compared with medical treatment of gastroesophageal reflux disease (GERD) and to the background population.
GERD is causally associated with EAC. Effective symptomatic treatment can be achieved with medication and antireflux surgery; however the possible preventive effect on EAC development remains unclear.
This systematic review identified 10 studies comparing EAC risk after antireflux surgery with nonoperated GERD patients, including 7 studies of patients with Barrett's esophagus, and 2 studies comparing EAC risk after antireflux surgery to the background population. A fixed-effects Poisson meta-analysis was conducted to calculate pooled incidence rate ratios (IRR) and 95% confidence intervals (CIs).
The pooled IRR in patients after antireflux surgery was 0.76 (95% CI 0.42-1.39) compared with medically treated GERD patients. In patients with Barrett's esophagus, the corresponding IRR was 0.46 (95% CI 0.20-1.08), and 0.26 (95% CI 0.09-0.79) when restricted to publications after 2000. There was no difference in EAC risk between antireflux surgery and medical treatment in GERD patients without known Barrett's esophagus (IRR 0.98, 95% CI 0.72-1.33). The EAC risk remained elevated in patients after antireflux surgery compared with the background population (IRR 10.78, 95% CI 8.48-13.71). Although the clinical heterogeneity of the included studies was high, the statistical heterogeneity was low.
Antireflux surgery may prevent EAC better than medical therapy in patients with Barrett's esophagus. The EAC risk after antireflux surgery does not seem to revert to that of the background population.
与胃食管反流病（GERD）的药物治疗及普通人群相比，探讨抗反流手术对食管腺癌（EAC）的预防作用。
GERD与EAC存在因果关系。药物治疗和抗反流手术均可有效缓解症状；然而，其对EAC发生的潜在预防作用仍不明确。
本系统评价纳入了10项研究，比较抗反流手术后EAC风险与未手术的GERD患者，其中7项研究针对巴雷特食管患者，2项研究比较抗反流手术后EAC风险与普通人群。采用固定效应泊松荟萃分析计算合并发病率比（IRR）及95%置信区间（CI）。
与接受药物治疗的GERD患者相比，抗反流手术后患者的合并IRR为0.76（95%CI 0.42-1.39）。在巴雷特食管患者中，相应的IRR为0.46（95%CI 0.20-1.08），若仅纳入2000年后发表的研究，该值为0.26（95%CI 0.09-0.79）。在无巴雷特食管的GERD患者中，抗反流手术与药物治疗的EAC风险无差异（IRR 0.98，95%CI 0.72-1.33）。与普通人群相比，抗反流手术后患者的EAC风险仍较高（IRR 10.78，95%CI 8.48-13.71）。尽管纳入研究的临床异质性较高，但统计异质性较低。
对于巴雷特食管患者，抗反流手术预防EAC的效果可能优于药物治疗。抗反流手术后的EAC风险似乎并未恢复至普通人群水平。
