Klink für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany.
World J Surg Oncol. 2019 Apr 15;17(1):68. doi: 10.1186/s12957-019-1600-1.
This meta-analysis sought to evaluate the potential benefits and harms of laparoscopic gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer versus open surgery.
A comprehensive search for randomized controlled studies that compared laparoscopic versus open gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer published until December 31, 2018, was conducted. Operative outcomes, early postoperative outcomes, and long-term results were analyzed using a random effects model.
Five randomized controlled trials containing a collective total of 2157 patients were included. In comparison with open surgery, laparoscopic gastrectomy for locally advanced gastric cancer showed similar risks of short-term mortality and serious adverse events within 30 days after surgery. Regarding intraoperative outcomes, operative time was increased for the laparoscopic approach, whereas the estimated intraoperative blood loss tended to be less. However, the amount of evidence was low for most outcomes. In addition, the results for the length of hospital stay and time to first flatus did not show statistically significant differences. The number of harvested lymph nodes and compliance with D2 lymphadenectomy did not significantly differ between the two groups, indicating oncological equivalence of both approaches. However, long-term oncological results could not be evaluated due to a lack of relevant data in four of the trials.
Laparoscopic gastrectomy with D2 lymphadenectomy can be performed with equivalent overall short-term morbidity and mortality versus the open approach for locally advanced gastric cancer. However, further well-designed randomized controlled trials are necessary to assess the possible advantages and risks of the laparoscopic approach as well as the long-term results.
本荟萃分析旨在评估腹腔镜下 D2 淋巴结清扫术与开腹手术治疗局部进展期胃癌的潜在获益与危害。
系统检索截至 2018 年 12 月 31 日比较腹腔镜与开腹 D2 淋巴结清扫术治疗局部进展期胃癌的随机对照试验。采用随机效应模型分析手术结局、术后早期结局和长期结果。
纳入 5 项随机对照试验，共计 2157 例患者。与开腹手术相比，腹腔镜下治疗局部进展期胃癌的短期死亡率和术后 30 天内严重不良事件风险相似。术中结局方面，腹腔镜手术的手术时间延长，但估计术中出血量较少。但大多数结局的证据质量较低。此外，两组患者的住院时间和首次排气时间无统计学差异。两组患者的淋巴结清扫数目和 D2 淋巴结清扫的符合率无显著差异，提示两种方法的肿瘤学效果相当。但由于四项试验缺乏相关数据，无法评估长期肿瘤学结果。
对于局部进展期胃癌，腹腔镜下 D2 淋巴结清扫术与开腹手术的总体短期发病率和死亡率相当。但需要进一步设计良好的随机对照试验来评估腹腔镜手术的潜在优势和风险，以及长期结果。
