Bestetti Alexandre Moraes, de Moura Diogo Turiani Hourneaux, Proença Igor Mendonça, Junior Epifanio Silvino do Monte, Ribeiro Igor Braga, Sasso João Guilherme Ribeiro Jordão, Kum Angelo So Taa, Sánchez-Luna Sergio A, Marques Bernardo Wanderley, de Moura Eduardo Guimarães Hourneaux
Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
Front Oncol. 2022 Jul 12;12:939244. doi: 10.3389/fonc.2022.939244. eCollection 2022.
Endoscopic resection (ER) is the preferred approach to treat early gastric cancer (EGC) in patients without suspected lymph node involvement and that meet the criteria for ER. Surgery is a more aggressive treatment, but it may be associated with less recurrence and the need for reintervention. Previous meta-analyses comparing ER with surgery for EGC did not incorporate the most recent studies, making accurate conclusions not possible.
This systematic review and meta-analysis aimed to examine complete resection, length of hospital stay (LOHS), adverse events (AEs), serious AEs, recurrence, 5-year overall survival (OS), and 5-year cancer-specific survival (CSS) in patients with EGC.
A total of 29 cohorts studies involving 20559 patients were included. The ER (n = 7709) group was associated with a lower incidence of AEs (RD = -0.07, 95%CI = -0.1, -0.04, p < 0.0001) and shorter LOHS (95% CI -5.89, -5.32; p < 0,00001) compared to surgery (n = 12850). However, ER was associated with lower complete resection rates (RD = -0.1, 95%CI = -0.15, -0.06; p < 0.00001) and higher rates of recurrence (RD = 0.07, 95%CI = 0.06; p < 0.00001). There were no significant differences between surgery and ER in 5-year OS (RD = -0.01, 95%CI = -0.04, 0.02; p = 0.38), 5-year CSS (RD = 0.01, 95%CI = 0.00, 0.02; p < 0.17), and incidence of serious AEs (RD = -0.03, 95%CI = -0.08, 0.01; p = 0.13).
ER and surgery are safe and effective treatments for EGC. ER provides lower rates of AEs and shorter LOHS compared to surgery. Although ER is associated with lower complete resection rates and a higher risk of recurrence, the OS and CSS were similar between both approaches.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021255328.
内镜下切除术（ER）是治疗无淋巴结转移可疑且符合ER标准的早期胃癌（EGC）患者的首选方法。手术是一种更积极的治疗方式，但可能复发率较低且再次干预需求较少。既往比较ER与手术治疗EGC的荟萃分析未纳入最新研究，无法得出准确结论。
本系统评价和荟萃分析旨在研究EGC患者的完整切除率、住院时间（LOHS）、不良事件（AE）、严重AE、复发率、5年总生存率（OS）和5年癌症特异性生存率（CSS）。
共纳入29项队列研究，涉及20559例患者。与手术组（n = 12850）相比，ER组（n = 7709）的AE发生率较低（RD = -0.07，95%CI = -0.1，-0.04，p < 0.0001），LOHS较短（95%CI -5.89，-5.32；p < 0.00001）。然而，ER的完整切除率较低（RD = -0.1，95%CI = -0.15，-0.06；p < 0.00001），复发率较高（RD = 0.07，95%CI = 0.06；p < 0.00001）。手术与ER在5年OS（RD = -0.01，95%CI = -0.04，0.02；p = 0.38）、5年CSS（RD = 0.01，95%CI = 0.00，0.02；p < 0.17）和严重AE发生率（RD = -0.03，95%CI = -0.08，0.01；p = 0.13）方面无显著差异。
ER和手术都是治疗EGC的安全有效方法。与手术相比，ER的AE发生率较低，LOHS较短。尽管ER的完整切除率较低且复发风险较高，但两种方法的OS和CSS相似。
