Hakkenbrak Nadia A G, Jansma Elise P, van der Wielen N, van der Peet Donald L, Straatman Jennifer
Department of Gastrointestinal Surgery, Amsterdam University Medical Center, Location VU Medical Center, the Netherlands.
Medical Library, Amsterdam University Medical Center, Location VU Medical Center, the Netherlands.
Surgery. 2022 Jun;171(6):1552-1561. doi: 10.1016/j.surg.2021.11.035. Epub 2022 Jan 31.
Laparoscopic distal gastrectomy (LDG) with adequate lymph node dissection for gastric cancer is increasingly being applied worldwide. Several randomized trials have been conducted regarding this surgical approach. The aim of this meta-analysis is to present an updated overview comparing laparoscopic distal gastrectomy and open distal gastrectomy (ODG) with regard to short-term results, long-term follow-up, and oncological outcomes.
An extensive search was conducted using the Medline, Embase, and Cochrane databases, including randomized clinical trials comparing LDG and open distal gastrectomy. Studies were assessed regarding outcomes for operative results, postoperative recovery, complications, mortality, adequacy of resection, and long-term survival.
In total, 2,347 articles were identified, and 22 randomized clinical trials were selected for analysis. Operative results showed significantly less blood loss and a longer operative time for LDG. Patients after LDG showed a faster recovery of bowel function, shorter hospitalization, and fewer complications, while mortality rates did not differ. Lymph node yield and resection margins were similar in both groups. Results regarding survival could not be analyzed due to a great diversity in follow-up duration.
Laparoscopic distal gastrectomy shows favorable outcomes, such as less perioperative blood loss, faster patient recovery, and fewer complications. Moreover, LDG is oncologically adequate regarding lymph node yield, adequacy of resection, and survival.
腹腔镜远端胃癌切除术（LDG）并进行充分的淋巴结清扫在全球范围内应用越来越广泛。针对这种手术方式已经开展了多项随机试验。本荟萃分析的目的是就短期结果、长期随访和肿瘤学结局，对腹腔镜远端胃癌切除术和开放远端胃癌切除术（ODG）进行比较，给出最新综述。
使用Medline、Embase和Cochrane数据库进行广泛检索，纳入比较LDG和开放远端胃癌切除术的随机临床试验。对手术结果、术后恢复、并发症、死亡率、切除充分性和长期生存等结局进行评估。
共检索到2347篇文章，选取22项随机临床试验进行分析。手术结果显示，LDG的术中出血量显著减少，但手术时间更长。LDG术后患者肠道功能恢复更快、住院时间更短、并发症更少，而死亡率无差异。两组的淋巴结获取数量和切缘情况相似。由于随访时间差异很大，无法对生存结果进行分析。
腹腔镜远端胃癌切除术显示出良好的结局，如围手术期出血量更少、患者恢复更快、并发症更少。此外，LDG在淋巴结获取数量、切除充分性和生存方面在肿瘤学上是足够的。
