Lu Wei, Gao Jian, Yang Jingyun, Zhang Yijian, Lv Wenjie, Mu Jiasheng, Dong Ping, Liu Yingbin
Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine Institute of Biliary Tract Diseases Research, Shanghai Jiao Tong University School of Medicine Department of Nutrition, Zhongshan hospital, Affiliated to Fudan University Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China Rush Alzheimer's Disease Center Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
Medicine (Baltimore). 2016 Jul;95(27):e3986. doi: 10.1097/MD.0000000000003986.
The objective of this study was to compare long-term surgical outcomes and complications of laparoscopy-assisted distal gastrectomy (LADG) with open distal gastrectomy (ODG) for the treatment of early gastric cancer (EGC) based on a review of available randomized controlled trials (RCTs) evaluated using the Cochrane methodology.RCTs comparing LADG and ODG were identified by a systematic literature search in PubMed, Cochrane Library, MEDLINE, EMBASE, Scopus, and the China Knowledge Resource Integrated Database, for papers published from January 1, 2003 to July 30, 2015. Meta-analyses were performed to compare the long-term clinical outcomes.Our systematic literature search identified 8 eligible RCTs including 732 patients (374 LADGs and 358 ODGs), with low overall risk of bias. Long-term mortality and relapse rate were comparable for both techniques. The long-term complication rate was 8.47% in LADG groups and 13.62% in the ODG group, indicating that LADG was associated with lower risk for long-term complications (RR = 0.63; 95%CI = 0.39-1.00; P = 0.03).In the treatment of EGC, LADG lowered the rate of long- and short-term complications and promoted earlier recovery, with comparable oncological outcomes to ODG.
本研究的目的是基于对采用Cochrane方法评估的现有随机对照试验（RCT）的综述，比较腹腔镜辅助远端胃切除术（LADG）与开放远端胃切除术（ODG）治疗早期胃癌（EGC）的长期手术效果和并发症。通过在PubMed、Cochrane图书馆、MEDLINE、EMBASE、Scopus和中国知网数据库中进行系统的文献检索，确定了2003年1月1日至2015年7月30日发表的比较LADG和ODG的RCT。进行荟萃分析以比较长期临床结果。我们的系统文献检索确定了8项符合条件的RCT，包括732例患者（374例行LADG，358例行ODG），总体偏倚风险较低。两种技术的长期死亡率和复发率相当。LADG组的长期并发症发生率为8.47%，ODG组为13.62%，这表明LADG的长期并发症风险较低（RR = 0.63；95%CI = 0.39 - 1.00；P = 0.03）。在EGC的治疗中，LADG降低了短期和长期并发症的发生率，促进了更早的恢复，肿瘤学结果与ODG相当。
