Pyo Jung-Soo, Son Byoung Kwan, Lee Hyo Young, Oh Il Hwan, Chung Kwang Hyun
Department of Pathology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea.
Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul 01830, Korea.
Medicina (Kaunas). 2020 Oct 18;56(10):546. doi: 10.3390/medicina56100546.
This study aimed to elucidate the clinical outcomes of endoscopic resection (ER) through comparison with surgical resection (SR) through a meta-analysis. This meta-analysis was performed using 32 studies. The complete resection and recurrence rates of treatment for ampullary tumors were investigated and compared between ER and SR. In addition, complications, including pancreatitis, cholangitis, cholecystitis, perforation, and papillary stenosis, and mortality of ER and SR, respectively, were estimated. The rates of complete resection were 0.812 (95% confidence interval, CI, 0.758-0.856) and 0.929 (95% CI 0.739-0.984) in ER and SR, respectively. Recurrence rates were 0.145 (95% CI 0.107-0.193) and 0.126 (95% CI 0.057-0.257) in ER and SR, respectively. There were no significant differences in complete resection and recurrence rates between ER and SR in the meta-regression tests ( = 0.164 and = 0.844, respectively). The estimated rates of pancreatitis, cholangitis/cholecystitis, perforation, and papillary stenosis were 12.8%, 4.4%, 5.2%, and 4.3% in ER and 9.9%, 5.6%, 2.3%, and 5.6% in SR, respectively. There was no significant difference in complications between ER and SR. The mortality rate of SR was slightly higher than that of ER (0.041, 95% CI 0.015-0.107 vs. 0.031, 95% CI 0.005-0.162). Our results show that ER had no significant differences in terms of complete resection and recurrence rates compared to SR, regardless of tumor behaviors. By comparing the complication and mortality rates between ER and SR, the safety of ER was proven.
本研究旨在通过荟萃分析比较内镜切除术（ER）与手术切除术（SR）的临床结局。本荟萃分析使用了32项研究。对壶腹肿瘤治疗的完整切除率和复发率进行了研究，并在ER和SR之间进行了比较。此外，分别估算了ER和SR的并发症，包括胰腺炎、胆管炎、胆囊炎、穿孔和乳头狭窄，以及死亡率。ER和SR的完整切除率分别为0.812（95%置信区间，CI，0.758 - 0.856）和0.929（95%CI 0.739 - 0.984）。ER和SR的复发率分别为0.145（95%CI 0.107 - 0.193）和0.126（95%CI 0.057 - 0.257）。在荟萃回归检验中，ER和SR之间的完整切除率和复发率无显著差异（分别为 = 0.164和 = 0.844）。ER中胰腺炎、胆管炎/胆囊炎、穿孔和乳头狭窄的估计发生率分别为12.8%、4.4%、5.2%和4.3%，SR中分别为9.9%、5.6%、2.3%和5.6%。ER和SR之间的并发症无显著差异。SR的死亡率略高于ER（0.041，95%CI 0.015 - 0.107对0.031，95%CI 0.005 - 0.162）。我们的结果表明，无论肿瘤行为如何，ER与SR相比，在完整切除率和复发率方面无显著差异。通过比较ER和SR之间的并发症和死亡率，证明了ER的安全性。
