Xiangya hospital, Central South University, Changsha, China.
Taoyuan People's Hospital, Taoyuan, Changde, China.
World J Surg Oncol. 2020 Jan 27;18(1):20. doi: 10.1186/s12957-020-1795-1.
Compared with open gastrectomy (OG), laparoscopic gastrectomy (LG) for gastric cancer has achieved rapid development and popularities in the past decades. However, lack of comprehensive analysis in long-term oncological outcomes such as recurrence and mortality hinder its full support as a valid procedure. Therefore, there are still debates on whether one of these options is superior.
To evaluate the primary and secondary outcomes of laparoscopic versus open gastrectomy for gastric cancer patients METHODS: Two authors independently extracted study data. Risk ratio (RR) with 95% confidence interval (CI) was calculated for binary outcomes, mean difference (MD) or the standardized mean difference (SMD) with 95% CI for continuous outcomes, and the hazard ratio (HR) for time-to-event outcomes. Review Manager 5.3 and STATA software were used for the meta-analysis.
Seventeen randomized controlled trials (RCTs) involving 5204 participants were included in this meta-analysis. There were no differences in the primary outcomes including the number of lymph nodes harvested during operation, severe complications, short-term and long-term recurrence, and mortality. As for secondary outcomes, compared with the OG group, longer operative time was required for patients in the LG group (MD = 58.80 min, 95% CI = [45.80, 71.81], P < 0.001), but there were less intraoperative blood loss (MD = - 54.93 ml, 95% CI = [- 81.60, - 28.26], P < 0.001), less analgesic administration (frequency: MD = - 1.73, 95% CI = [- 2.21, - 1.24], P < 0.001; duration: MD = - 1.26 days, 95% CI = [- 1.40, - 1.12], P < 0.001), shorter hospital stay (MD = - 1.37 days, 95% CI = [- 2.05, - 0.70], P < 0.001), shorter time to first flatus (MD = - 0.58 days, 95% CI = [- 0.79, - 0.37], P < 0.001), ambulation (MD = - 0.50 days, 95% CI = [- 0.90, - 0.09], P = 0.02) and oral intake (MD = - 0.64 days, 95% CI = [- 1.24, - 0.03], P < 0.04), and less total complications (RR = 0.81, 95% CI = [0.71, 0.93], P = 0.003) in the OG group. There was no difference in blood transfusions (number, quantity) between these two groups. Subgroup analysis, sensitivity analysis, and the adjustment of Duval's trim and fill methods for publication bias did not change the conclusions.
LG was comparable to OG in the primary outcomes and had some advantages in secondary outcomes for gastric cancer patients. LG is superior to OG for gastric cancer patients.
与开腹胃切除术（OG）相比，腹腔镜胃切除术（LG）在过去几十年中得到了快速发展和普及。然而，缺乏对复发和死亡率等长期肿瘤学结果的全面分析，阻碍了其作为有效手术的全面支持。因此，对于这两种选择中哪一种更优，仍存在争议。
评估腹腔镜与开腹胃切除术治疗胃癌患者的主要和次要结局。
两位作者独立提取研究数据。对于二分类结局，采用风险比（RR）及其 95%置信区间（CI）进行计算，对于连续性结局，采用均数差（MD）或标准化均数差（SMD）及其 95%CI 进行计算，对于生存时间结局，采用风险比（HR）进行计算。采用 Review Manager 5.3 和 STATA 软件进行荟萃分析。
本荟萃分析纳入了 17 项随机对照试验（RCTs），涉及 5204 名参与者。两组之间在手术中淋巴结清扫数量、严重并发症、短期和长期复发以及死亡率等主要结局方面无差异。对于次要结局，与 OG 组相比，LG 组的手术时间更长（MD=58.80 分钟，95%CI=[45.80, 71.81]，P<0.001），但术中出血量更少（MD=-54.93 毫升，95%CI=[-81.60, -28.26]，P<0.001），需要的镇痛药物更少（频率：MD=-1.73，95%CI=[-2.21, -1.24]，P<0.001；持续时间：MD=-1.26 天，95%CI=[-1.40, -1.12]，P<0.001），住院时间更短（MD=-1.37 天，95%CI=[-2.05, -0.70]，P<0.001），首次排气时间更早（MD=-0.58 天，95%CI=[-0.79, -0.37]，P<0.001），下床活动时间更早（MD=-0.50 天，95%CI=[-0.90, -0.09]，P=0.02），开始口服饮食时间更早（MD=-0.64 天，95%CI=[-1.24, -0.03]，P<0.04），总并发症发生率更低（RR=0.81，95%CI=[0.71, 0.93]，P=0.003）。两组间输血的数量和量无差异。亚组分析、敏感性分析和 Duval 的修剪和填充法调整出版偏倚均未改变结论。
LG 在主要结局方面与 OG 相当，在次要结局方面具有一些优势。对于胃癌患者，LG 优于 OG。
