Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China.
Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China.
Int J Surg. 2022 Jun;102:106678. doi: 10.1016/j.ijsu.2022.106678. Epub 2022 May 16.
Laparoscopic gastrectomy (LG) has been widely used for advanced gastric cancer (GC), and its resection extent is not limited to distal gastrectomy. However, the superiority of this minimally invasive approach remains controversial. This study aimed to evaluate the benefits and risks of LG on the short- and long-term outcomes compared with open gastrectomy (OG) for GC.
A systematic literature search was performed to identify randomized controlled trials (RCTs) comparing LG and OG for treatment of GC. The primary outcomes were adverse events, recurrence, mortality, and the quality of life. The secondary outcomes included operation-relevant outcomes and postoperative recovery outcomes. We employed random-effects meta-analyses to pool results with Hartung-Knapp adjustment. The prediction interval (PI) was used to quantify the between-study heterogeneity. Meta-regression and subgroup analyses were performed to examine the potential sources of heterogeneity.
Twenty-eight studies involving 7643 patients were included. Most studies (22 out of 28) reported results from experienced surgeons. Compared to OG, LG was found to have the advantages of less blood loss, fewer postoperative complications, and faster recovery, but at the expense of lesser proximal resection margin length, longer operation time, and fewer retrieved lymph nodes. There were no significant differences for anastomosis-related complications, recurrence and survival and other outcomes between LG and OG. Significant between-study heterogeneity was observed. Body mass index (BMI) and age were two major sources of heterogeneity.
For experienced surgeons, LG is an alternative approach to OG for patients with GC. Patients with lower BMI and older age may benefit most from LG. Future studies are needed to confirm our findings in low-volume hospitals and for less-experienced surgeons. Future trials focusing on patient-important outcomes are warranted for clinical decision-making.
腹腔镜胃切除术（LG）已广泛应用于进展期胃癌（GC），其切除范围不限于远端胃切除术。然而，这种微创方法的优势仍存在争议。本研究旨在评估与开腹胃切除术（OG）相比，LG 在 GC 的短期和长期结局方面的获益和风险。
系统检索了比较 LG 和 OG 治疗 GC 的随机对照试验（RCT）。主要结局是不良事件、复发、死亡率和生活质量。次要结局包括手术相关结局和术后恢复结局。我们采用随机效应荟萃分析，采用 Hartung-Knapp 调整对结果进行汇总。预测区间（PI）用于量化研究间异质性。进行荟萃回归和亚组分析以检查异质性的潜在来源。
纳入了 28 项研究，共涉及 7643 例患者。大多数研究（28 项中的 22 项）报告了经验丰富的外科医生的结果。与 OG 相比，LG 具有出血量少、术后并发症少、恢复快的优点，但近端切除范围较短、手术时间较长、淋巴结检出数较少。LG 和 OG 之间在吻合口相关并发症、复发和生存等其他结局方面无显著差异。存在显著的研究间异质性。体重指数（BMI）和年龄是异质性的两个主要来源。
对于经验丰富的外科医生，LG 是 GC 患者 OG 的替代方法。BMI 较低和年龄较大的患者可能从 LG 中获益最大。未来需要在低容量医院和经验较少的外科医生中进行研究来证实我们的发现。未来的试验需要关注对患者重要的结局，以做出临床决策。
