Department of Gastric Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China.
Department of Gastric Surgery, The 6th Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
World J Surg Oncol. 2018 Mar 27;16(1):66. doi: 10.1186/s12957-018-1354-1.
The present meta-analysis was to explore the surgical and oncological outcomes of bursectomy for advanced gastric cancer (AGC).
Relevant studies that evaluated the role of bursectomy for AGC were comprehensively examined to perform a meta-analysis. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcomes were the number of harvested lymph nodes (LNs), operation time, operative bleeding, hospital stay, postoperative complication and mortality.
A total of seven studies comprising 2633 cases (1176 cases in the bursectomy group and 1457 cases in the non-bursectomy group) were finally included. There was no significant difference in OS (HR 0.95, P = 0.647) and DFS (HR 0.99, P = 0.936) between the two groups. Even for patients with serosa-penetrating tumours, OS was comparable between the two groups (HR 0.87, P = 0.356). The operation time of the bursectomy group was longer (weighted mean difference, WMD 32.76 min, P = 0.002). No significant difference was found between the two groups in terms of the number of dissected LNs (WMD 5.86, P = 0.157), operative bleeding (WMD 66.99 ml, P = 0.192) and hospital stay (WMD - 0.15 days, P = 0.766). The overall postoperative complication (relative risk, RR 1.08, P = 0.421) and mortality (RR 0.44, P = 0.195) were similar between two groups.
This meta-analysis indicated that bursectomy is time-consuming without increasing the number of harvested LNs. Although bursectomy can be safely performed without increasing complications and mortality, it does not prolong the OS and DFS of AGC patients, including patients with serosa-penetrating tumours. Therefore, bursectomy should not be recommended as a standard procedure for AGC.
本荟萃分析旨在探讨胃腺癌（AGC）患者行全胃系膜切除术的手术和肿瘤学结果。
全面检索评估全胃系膜切除术在 AGC 中作用的相关研究，进行荟萃分析。主要结局指标为总生存（OS）和无病生存（DFS）。次要结局指标包括清扫的淋巴结（LNs）数量、手术时间、术中出血量、住院时间、术后并发症和死亡率。
最终纳入 7 项研究共 2633 例患者（全胃系膜切除术组 1176 例，非全胃系膜切除术组 1457 例）。两组患者 OS（HR 0.95，P=0.647）和 DFS（HR 0.99，P=0.936）差异均无统计学意义。即使对于穿透浆膜的肿瘤患者，两组 OS 也无差异（HR 0.87，P=0.356）。全胃系膜切除术组手术时间更长（加权均数差，WMD 32.76 分钟，P=0.002）。两组患者清扫的 LNs 数量（WMD 5.86，P=0.157）、术中出血量（WMD 66.99 毫升，P=0.192）和住院时间（WMD -0.15 天，P=0.766）差异均无统计学意义。两组患者总的术后并发症发生率（相对危险度，RR 1.08，P=0.421）和死亡率（RR 0.44，P=0.195）相似。
本荟萃分析表明，全胃系膜切除术虽然耗时，但并不能增加清扫的 LNs 数量。尽管全胃系膜切除术可以安全实施，不会增加并发症和死亡率，但并不能延长 AGC 患者（包括穿透浆膜的肿瘤患者）的 OS 和 DFS，因此不应推荐全胃系膜切除术作为 AGC 的标准手术方式。
