晚期胃癌患者腹腔镜与开腹胃切除术的短期和长期结局比较：一项随机对照试验的Meta分析
The Comparison of Short- and Long-Term Outcomes for Laparoscopic Versus Open Gastrectomy for Patients With Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials.
作者信息
Jiang Jinyan, Ye Guanxiong, Wang Jun, Xu Xiaoya, Zhang Kai, Wang Shi
机构信息
Department of Nursing, Lishui People's Hospital, Lishui, China.
Department of General Surgery, Lishui People's Hospital, Lishui, China.
出版信息
Front Oncol. 2022 Apr 5;12:844803. doi: 10.3389/fonc.2022.844803. eCollection 2022.
OBJECTIVES
The effect of laparoscopic gastrectomy (LG) for the treatment of advanced gastric cancer (AGC) is still controversial. The aim of this meta-analysis was to contrast the short- and long-term outcomes of laparoscopic versus conventional open gastrectomy (OG) for patients with AGC.
METHODS
Databases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until December 2021 for randomized controlled trial-enrolled patients undergoing LG or OG for the treatment of AGC. Short-term outcomes were overall postoperative complications, anastomotic leakage, number of retrieved lymph node, surgical time, blood loss, length of hospital stay, and short-term mortality. Long-term outcomes were survival rates at 1, 3, and 5 years.
RESULTS
A total of 12 trials involving 4,101 patients (2,059 in LG group, 2,042 in OG group) were included. No effect on overall postoperative complications (OR 0.84, 95% CI 0.67 to 1.05, p = 0.12, I = 34%) and anastomotic leakage (OR 1.26, 95% CI 0.82 to 1.95, p = 0.30, I = 0%) was found. Compared with the open approach, patients receiving LG had fewer blood loss (MD -54.38, 95% CI -78.09 to -30.67, p < 0.00001, I = 90%) and shorter length of hospital stay (MD -1.25, 95% CI -2.08 to -0.42, p = 0.003, I = 86%). However, the LG was associated with a lower number of retrieved lymph nodes (MD -1.02, 95% CI -1.77 to -0.27, p = 0.008, I = 0%) and longer surgical time (MD 40.87, 95% CI 20.37 to 54.44, p < 0.00001, I = 94%). Furthermore, there were no differences between LG and OG groups in short-term mortality and survival rate at 1, 3, and 5 years.
CONCLUSIONS
LG offers improved short-term outcomes including shorter hospital stays and fewer blood loss, with comparable postoperative complications, short-term mortality, and survival rate at 1, 3, and 5 years when compared to the open approach. Our results support the implementation of LG in patients with AGC.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD 42021297141).
目的
腹腔镜胃切除术（LG）治疗进展期胃癌（AGC）的效果仍存在争议。本荟萃分析的目的是对比AGC患者接受腹腔镜与传统开放胃切除术（OG）的短期和长期结局。
方法
系统检索包括PubMed、Embase、Scopus和Cochrane图书馆在内的数据库，直至2021年12月，纳入接受LG或OG治疗AGC的随机对照试验患者。短期结局包括术后总体并发症、吻合口漏、淋巴结清扫数量、手术时间、失血量、住院时间和短期死亡率。长期结局为1年、3年和5年生存率。
结果
共纳入12项试验，涉及4101例患者（LG组2059例，OG组2042例）。未发现对术后总体并发症（OR 0.84，95%CI 0.67至1.05，p = 0.12，I² = 34%）和吻合口漏（OR 1.26，95%CI 0.82至1.95，p = 0.30，I² = 0%）有影响。与开放手术相比，接受LG的患者失血量更少（MD -54.38，95%CI -78.09至-30.67，p < 0.00001，I² = 90%），住院时间更短（MD -1.25，95%CI -2.08至-0.42，p = 0.003，I² = 86%）。然而，LG组淋巴结清扫数量较少（MD -1.02，95%CI -1.77至-0.27，p = 0.008，I² = 0%），手术时间更长（MD 40.87，95%CI 20.37至54.44，p < 0.00001，I² = 94%）。此外，LG组和OG组在短期死亡率以及1年、3年和5年生存率方面无差异。
结论
与开放手术相比，LG具有改善的短期结局，包括住院时间更短和失血量更少，术后并发症、短期死亡率以及1年、3年和5年生存率相当。我们的结果支持对AGC患者实施LG。
系统评价注册
PROSPERO（CRD 42021297141）
Zotero 插件