Mao Xinyu, Xu Xinlei, Zhu Hua, Ji Chunpeng, Lu Xu, Wang Baolin
Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210011, Jiangsu, China.
World J Surg Oncol. 2020 Jul 8;18(1):160. doi: 10.1186/s12957-020-01910-y.
Due to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG). However, controversies still persist regarding the surgical efficacy and oncological safety of PPG.
Original studies comparing PPG and DG for EGC were searched in PubMed, Embase, and the Cochrane Register of Controlled Trials up to December 2019. The weight mean difference, standardized mean difference, or odds risk was used to calculate the short-term and long-term outcomes between the two groups.
Twenty-one comparative studies comprising 4871 patients (1955 in the PPG group and 2916 in the DG group) were enrolled in this systematic review and meta-analysis. PPG showed longer hospital day, decreased harvested lymph nodes, and more delayed gastric emptying. However, PPG had the benefits of lower incidence of anastomosis leakage, early dumping syndrome, gastritis and bile reflux, and better recovery of total protein, albumin, hemoglobin, and weight. No difference was found in operative time, blood loss, and overall complications. Moreover, the long-term survival and recurrence rate were similar in two groups.
Owing to the non-inferiority of surgery and oncology outcomes and the superiority of function outcomes in PPG, we revealed that PPG can be clinically applicable instead of DG in EGC. However, more high-quality comparative studies and randomized clinical trials would be required for further confirmation.
由于功能预后更好，保留幽门胃切除术（PPG）已被广泛应用于早期胃癌（EGC）患者，作为远端胃切除术（DG）的替代方案。然而，关于PPG的手术疗效和肿瘤学安全性仍存在争议。
检索了截至2019年12月在PubMed、Embase和Cochrane对照试验注册库中比较PPG和DG治疗EGC的原始研究。采用加权均数差、标准化均数差或比值比来计算两组之间的短期和长期结局。
本系统评价和荟萃分析纳入了21项比较研究，共4871例患者（PPG组1955例，DG组2916例）。PPG显示住院时间更长、获取的淋巴结减少以及胃排空延迟。然而，PPG具有吻合口漏、早期倾倒综合征、胃炎和胆汁反流发生率较低，以及总蛋白、白蛋白、血红蛋白和体重恢复较好的优势。两组在手术时间、失血量和总体并发症方面未发现差异。此外，两组的长期生存率和复发率相似。
由于PPG在手术和肿瘤学结局方面不劣于DG，且在功能结局方面具有优势，我们发现PPG在EGC中可在临床上替代DG应用。然而，需要更多高质量的比较研究和随机临床试验来进一步证实。
