Ye Liangying, Wu Xiaojing, Wu Tongwei, Wu Qijing, Liu Zhao, Liu Chuan, Li Sen, Chen Tao
The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China.
Department of Spinal Surgery, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China.
PLoS One. 2017 May 9;12(5):e0177193. doi: 10.1371/journal.pone.0177193. eCollection 2017.
This meta-analysis compared laparoscopic surgery (LAP) and open resection (OPEN) for the treatment of gastric gastrointestinal stromal tumors (GISTs) with regard to feasibility and safety.
We searched PubMed, Embase, and Web of Science for studies published before March 2016 comparing the LAP and OPEN procedures for GISTs. RevMan 5.1 software was used for the meta-analysis.
In total, 28 studies met the inclusion criteria for the meta-analysis. The mean tumor sizes in the OPEN and LAP groups were 4.54 and 5.67 cm. Compared with the OPEN patients, the LAP patients experienced shorter surgical times (P = 0.05), less blood loss (P<0.01), earlier time to flatus (P<0.01) and an oral diet (P<0.01), and shorter hospital stays (P<0.01). The LAP patients also exhibited a decrease in overall complications (P<0.01). In addition, regarding the subgroup of larger GISTs (>5 cm), the present study did not report significant differences in operation time (P = 0.93), postoperative complications (P = 0.30), or recurrence rate (P = 0.61) between the two groups, though LAP was associated with favorable results regarding blood loss (P = 0.03) and hospital stay (P<0.01).
Compared with the OPEN procedure, the LAP procedure is associated with preferable short-term postoperative outcomes and does not compromise long-term oncological outcomes. For gastric GISTs >5 cm, no significant difference was detected between LAP and OPEN if patient selection and intraoperative decisions were carefully considered.
本荟萃分析比较了腹腔镜手术（LAP）和开放切除术（OPEN）治疗胃胃肠道间质瘤（GIST）的可行性和安全性。
我们检索了PubMed、Embase和Web of Science，以查找2016年3月之前发表的比较LAP和OPEN治疗GIST的研究。使用RevMan 5.1软件进行荟萃分析。
共有28项研究符合荟萃分析的纳入标准。开放组和腹腔镜组的平均肿瘤大小分别为4.54 cm和5.67 cm。与开放手术患者相比，腹腔镜手术患者的手术时间更短（P = 0.05），失血量更少（P<0.01），排气时间更早（P<0.01），开始经口饮食时间更早（P<0.01），住院时间更短（P<0.01）。腹腔镜手术患者的总体并发症也有所减少（P<0.01）。此外，对于较大GIST（>5 cm）的亚组，本研究未报告两组在手术时间（P = 0.93）、术后并发症（P = 0.30）或复发率（P = 0.61）方面存在显著差异，尽管腹腔镜手术在失血量（P = 0.03）和住院时间（P<0.01）方面有较好的结果。
与开放手术相比，腹腔镜手术具有更好的术后短期疗效，且不影响长期肿瘤学结局。对于直径>5 cm的胃GIST，如果仔细考虑患者选择和术中决策，腹腔镜手术和开放手术之间未发现显著差异。
