Lai Hao, Yi Zhen, Long Di, Liu Jungang, Qin Haiquan, Mo Xianwei, Zhong Huage, Lin Yuan, Li Zhao
Department of Gastrointestinal Surgery, Guangxi Cancer Hospital, 71 Hedi Road.
Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University.
Medicine (Baltimore). 2020 Oct 16;99(42):e22525. doi: 10.1097/MD.0000000000022525.
Reduced-port surgery, in which fewer ports are used than those in conventional laparoscopic surgery, is becoming increasingly popular for various procedures. However, the application of reduced-port surgery to the gastrectomy field is still underdeveloped. The aim of this study was to use meta-analysis to address the potentially important advantages of this surgical technique.
Embase, PubMed, and Cochrane Library databases were systematically reviewed (through October 2019) to identify studies that compared reduced-port (RPLG) and conventional laparoscopic-assisted gastrectomy (CLG) in patients with gastric carcinoma. The endpoints were postoperative time, length of in-hospital stay, blood loss, retrieved lymph nodes, postoperative complications, time to first flatus, and aesthetic outcome.
A total of 11 studies, which included 1743 patients (907 RPLG and 836 CLG), were ultimately included in this analysis. Better aesthetic results: were obtained with RPLG (risk ratio 1.578; 95%CI, 1.377-1.808; P = .000), although length of in-hospital stay (standard mean difference [SMD] -0.106; 95% CI, -0.222 to 0.010; P = .074), time to first flatus (SMD -0.006; 95%CI, -0.123 to 0.110; P = .913), and perioperative complications (risk ratio 0.255; 95%CI, 0.142-0.369; P = .478) were equivalent. However, operative time was significantly longer (SMD 0.301; 95%CI, 0.194-0.409; P = .00), blood loss was greater (SMD -0.31; 95%CI, -0.415 to 0.205; P = .000), and fewer lymph nodes were harvested (SMD 0.255; 95%CI, 0.142-0.369; P = .000) in the RPLG group.
Our meta-analysis showed that RPLG is as safe as the CLG approach and offers better aesthetic results for patients with gastric carcinoma. However, basing on current evidence, RPLG was not an efficacious surgical alternative to CLG, as operative time was significantly longer, blood loss was greater, and fewer lymph nodes were harvested in the RPLG group. Additional high-powered controlled randomized trials are required, to determine whether RPLG truly offers any advantages; these future studies should particularly focus on pain scores and aesthetic outcomes.
与传统腹腔镜手术相比，使用端口更少的缩小端口手术在各种手术中越来越受欢迎。然而，缩小端口手术在胃切除术领域的应用仍不发达。本研究的目的是通过荟萃分析来探讨这种手术技术潜在的重要优势。
系统回顾了Embase、PubMed和Cochrane图书馆数据库（截至2019年10月），以确定比较缩小端口腹腔镜胃切除术（RPLG）和传统腹腔镜辅助胃切除术（CLG）治疗胃癌患者的研究。终点指标为术后时间、住院时间、失血量、获取的淋巴结数量、术后并发症、首次排气时间和美学效果。
本分析最终纳入了11项研究，共1743例患者（907例RPLG和836例CLG）。RPLG获得了更好的美学效果（风险比1.578；95%置信区间，1.377 - 1.808；P = 0.000），尽管住院时间（标准化均数差[SMD] -0.106；95%置信区间，-0.222至0.010；P = 0.074）、首次排气时间（SMD -0.006；95%置信区间，-0.123至0.110；P = 0.913）和围手术期并发症（风险比0.255；95%置信区间，0.142 - 0.369；P = 0.478）相当。然而，RPLG组的手术时间明显更长（SMD 0.301；95%置信区间，0.194 - 0.409；P = 0.00），失血量更大（SMD -0.31；95%置信区间，-0.415至-0.205；P = 0.000），获取的淋巴结更少（SMD 0.255；95%置信区间，0.142 - 0.369；P = 0.000）。
我们的荟萃分析表明，RPLG与CLG方法一样安全，并且为胃癌患者提供了更好的美学效果。然而，基于目前的证据，RPLG并非CLG有效的手术替代方法，因为RPLG组的手术时间明显更长，失血量更大，获取的淋巴结更少。需要更多高质量的对照随机试验来确定RPLG是否真的具有任何优势；这些未来的研究应特别关注疼痛评分和美学效果。
