腹腔镜与开腹胃癌根治术治疗高危胃癌患者的系统评价和荟萃分析。

Laparoscopic versus open gastrectomy for high-risk patients with gastric cancer: A systematic review and meta-analysis.

机构信息

Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.

出版信息

Int J Surg. 2019 May;65:52-60. doi: 10.1016/j.ijsu.2019.03.003. Epub 2019 Mar 10.

DOI:10.1016/j.ijsu.2019.03.003

PMID:30867126

Abstract

BACKGROUND

It is still remains unclear whether high-risk patients with gastric cancer can benefit from the application of laparoscopic gastrectomy (LG). The aim of this systematic review was to evaluate the surgical and long-term outcomes after LG and open gastrectomy (OG) for high-risk patients with gastric cancer.

METHODS

We performed a systematic literature search in various databases from January 1994 to June 2018. Patients who had≥1 of the following conditions were defined as high-risk patients: (1) age≥70 years; (2) BMI≥30 kg/m; (3) ASA (American Society of Anesthesiologists) grade≥3; or (4) clinical T4 stage (cT4). The results were analyzed according to predefined criteria.

RESULTS

In the present meta-analysis, the outcomes of 12 non-randomized controlled studies enrolling 1651 patients (873 in the LG group and 778 in the OG group) were pooled. The estimated blood loss was significantly lower in the LG group than those in the OG group (P < 0.01). There was no significant difference between two groups in operative time (P = 0.17) and number of harvested lymph nodes (P = 0.21). In the LG group, the time to flatus (P < 0.01), time to food intake (P < 0.01), and postoperative hospital stay (P < 0.01) were significantly shorter than those in the OG group. A lower overall postoperative complication rate was observed in the LG group (P < 0.01). The incidence of surgical (P < 0.01) and non-surgical (P < 0.01) complication was significantly lower in the LG group than that in the OG group. The pooled analysis showed no significant difference in overall survival (OS) between LG and OG groups (P = 0.98).

CONCLUSIONS

LG can be a safe and feasible procedure for high-risk patients with gastric cancer.

摘要

背景

目前仍不清楚腹腔镜胃切除术（LG）是否能使高危胃癌患者获益。本系统评价的目的是评估 LG 和开腹胃切除术（OG）治疗高危胃癌患者的手术和长期疗效。

方法

我们从 1994 年 1 月至 2018 年 6 月在多个数据库中进行了系统文献检索。将符合以下至少 1 种条件的患者定义为高危患者：（1）年龄≥70 岁；（2）BMI≥30kg/m；（3）ASA（美国麻醉医师协会）分级≥3 级；或（4）临床 T4 期（cT4）。根据预先设定的标准对结果进行分析。

结果

本 meta 分析纳入了 12 项非随机对照研究，共纳入 1651 例患者（LG 组 873 例，OG 组 778 例）。LG 组的估计出血量明显低于 OG 组（P<0.01）。两组的手术时间（P=0.17）和清扫淋巴结数目（P=0.21）无显著差异。LG 组患者术后肛门排气时间（P<0.01）、术后开始进食时间（P<0.01）和术后住院时间（P<0.01）均显著短于 OG 组。LG 组患者的总术后并发症发生率较低（P<0.01）。LG 组的手术（P<0.01）和非手术（P<0.01）并发症发生率均显著低于 OG 组。汇总分析显示，LG 组和 OG 组的总生存（OS）无显著差异（P=0.98）。