Li Zonglin, Song Min, Zhou Yejiang, Jiang Huaiwu, Xu Linxia, Hu Zhengchuan, Liu Yi, Jiang Yifan, Li Xin
Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Front Oncol. 2021 Sep 3;11:710814. doi: 10.3389/fonc.2021.710814. eCollection 2021.
Complete omentectomy is considered to be essential in the radical gastrectomy for gastric cancer (GC), but its clinical benefit remains unclear. This study aims to evaluate the efficacy of omentum-preserving gastrectomy (OPG) for patients with GC.
Studies comparing the surgical and oncological outcomes of OPG and gastrectomy with complete omentectomy (GCO) for GC up to March 2021 were systematically searched from PubMed, Web of Science, Embase, and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, surgical and oncological outcomes. The RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.
Nine studies with a total of 3335 patients (1372 in the OPG group and 1963 in the GCO group) undergoing gastrectomy were included. In the pooled analysis, the baseline data in two groups were all comparable (p > 0.05). However, the OPG group was associated with shorter operative time (MD = -18.67, 95% CI = -31.42 to -5.91, P = 0.004) and less intraoperative blood loss (MD = -38.09, 95% CI = -53.78 to -22.41, P < 0.00001) than the GCO group. However, the number of dissected lymph nodes (MD = 2.16, 95% CI = -0.61 to 4.93, P = 0.13), postoperative complications (OR = 0.92, 95% CI = 0.74 to 1.15, p = 0.47), overall recurrence rate (OR = 0.83, 95% CI = 0.66 to 1.06, p = 0.14), peritoneal recurrence rate (OR = 0.91, 95% CI = 0.65 to 1.29, p = 0.60), 3-year relapse-free survival (RFS) rate (OR = 1.40, 95% CI = 0.86 to 2.27, p = 0.18), and 5-year RFS rate (OR = 1.21, 95% CI = 0.95 to 1.55, p = 0.12) of the two groups were comparable.
OPG might be an oncologically safe procedure with better surgical outcomes for patients with GC than GCO. However, high-quality randomized controlled trials are needed to confirm this benefit.
在胃癌根治性胃切除术中，完整网膜切除术被认为是必不可少的，但它的临床益处仍不明确。本研究旨在评估保留大网膜胃切除术（OPG）对胃癌患者的疗效。
系统检索了截至2021年3月在PubMed、科学网、Embase和Cochrane图书馆上发表的比较OPG与完整网膜切除术（GCO）治疗胃癌的手术和肿瘤学结局的研究。对有关基线特征、手术和肿瘤学结局的可用数据进行汇总分析。使用RevMan 5.3软件进行统计分析。还进行了质量评估和发表偏倚分析。
纳入了9项研究，共有3335例患者接受了胃切除术（OPG组1372例，GCO组1963例）。在汇总分析中，两组的基线数据具有可比性（p>0.05）。然而，与GCO组相比，OPG组的手术时间更短（MD=-18.67，95%CI=-31.42至-5.91，P=0.004），术中出血量更少（MD=-38.09，95%CI=-53.78至-22.41，P<0.00001）。然而，两组的清扫淋巴结数量（MD=2.16，95%CI=-0.61至4.93，P=0.13）、术后并发症（OR=0.92，95%CI=0.74至1.15，p=0.47）、总复发率（OR=0.83，95%CI=0.66至1.06，p=0.14）、腹膜复发率（OR=0.91，95%CI=0.65至1.29，p=0.60）、3年无复发生存（RFS）率（OR=1.40，95%CI=0.86至2.27，p=0.18）和5年RFS率（OR=1.21，95%CI=0.95至1.55，p=0.12）具有可比性。
对于胃癌患者，OPG可能是一种肿瘤学上安全的手术，其手术结局优于GCO。然而，需要高质量的随机对照试验来证实这一益处。
