Inokuchi Mikito, Otsuki Sho, Ogawa Norihito, Tanioka Toshiro, Okuno Keisuke, Gokita Kentaro, Kawano Tatsuyuki, Kojima Kazuyuki
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan.
Department of Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan.
Gastroenterol Res Pract. 2016;2016:2617903. doi: 10.1155/2016/2617903. Epub 2016 Nov 30.
. Some meta-analyses of case-controlled studies (CCSs) have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG) had some short-term advantages over open total gastrectomy (OTG). However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. . CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients' status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. . This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients) from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG ( = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29-0.85, = 0.01, = 0%, and OR 0.46, 95% CI 0.17-0.52, < 0.0001, = 0%). However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG ( = 2,560; OR 1.44, 95% CI 0.96-2.16, = 0.08, = 0%). . LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.
一些病例对照研究（CCS）的荟萃分析表明，腹腔镜或腹腔镜辅助全胃切除术（LTG）相较于开放全胃切除术（OTG）具有一些短期优势。然而，各荟萃分析中术后并发症存在一定差异，且一些纳入荟萃分析的CCS中LTG和OTG之间存在因素不匹配的情况。在PubMed和Embase中检索比较LTG和OTG术后并发症的CCS。纳入对患者状态、肿瘤分期和淋巴结清扫范围进行匹配的研究。使用Review Manager 5.3版软件进行荟萃分析，评估感兴趣的结局，如吻合口、其他腹腔内、伤口和肺部并发症。该荟萃分析共纳入来自15项CCS的2560例患者（LTG组1073例患者；OTG组1487例患者）。LTG的伤口并发症发生率显著低于OTG（ = 2430；比值比[OR] 0.30，95%置信区间[CI] 0.29 - 0.85， = 0.01， = 0%，OR 0.46，95% CI 0.17 - 0.52， < 0.0001， = 0%）。然而，LTG的吻合口并发症发生率略高于OTG，但差异无统计学意义（ = 2560；OR 1.44，95% CI 0.96 - 2.16， = 0.08， = 0%）。在该CCS的荟萃分析中，LTG与OTG相比，术后伤口相关并发症发生率较低；然而，与LTG相关的吻合口问题仍存在一些担忧。
