Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China.
Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China.
Eur J Med Res. 2023 Jul 5;28(1):224. doi: 10.1186/s40001-023-01197-1.
Outcomes of laparoscopic surgery in advanced gastric cancer patients who received neoadjuvant therapy represent a controversial issue. We performed an updated meta-analysis to evaluate the perioperative and long-term survival outcomes of laparoscopic gastrectomy (LG) versus conventional open gastrectomy (OG) in this subset of patients.
Electronic databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were comprehensively searched up to May 2023. The short-term and long-term outcomes of LG versus OG in advanced gastric cancer patients undergoing neoadjuvant therapy were evaluated. Effect sizes with 95% confidence intervals were always assessed using random-effects model. The prospective protocol was registered with PROSPERO (CRD42022359126).
Eighteen studies (2 randomized controlled trials and 16 cohort studies) involving 2096 patients were included. In total, 933 patients were treated with LG and 1163 patients were treated with OG. In perioperative outcomes, LG was associated with less estimated blood loss (MD = - 65.15; P < 0.0001), faster time to flatus (MD = - 0.56; P < 0.0001) and liquid intake (MD = - 0.42; P = 0.02), reduced hospital stay (MD = - 2.26; P < 0.0001), lower overall complication rate (OR = 0.70; P = 0.002) and lower minor complication rate (OR = 0.69; P = 0.006), while longer operative time (MD = 25.98; P < 0.0001). There were no significant differences between the two groups in terms of proximal margin, distal margin, R1/R2 resection rate, retrieved lymph nodes, time to remove gastric tube and drainage tube, major complications and other specific complications. In survival outcomes, LG and OG were not significantly different in overall survival, disease-free survival and recurrence-free survival.
LG can be a safe and feasible technique for the treatment of advanced gastric cancer patients receiving neoadjuvant therapy. However, more high-quality randomized controlled trials are still needed to further validate the results of our study.
接受新辅助治疗的晚期胃癌患者接受腹腔镜手术的结果是一个有争议的问题。我们进行了一项更新的荟萃分析，以评估新辅助治疗的晚期胃癌患者中腹腔镜胃切除术（LG）与传统开腹胃切除术（OG）的围手术期和长期生存结局。
全面检索了 PubMed、Embase、Web of Science、Cochrane 对照试验中心注册库和中国国家知识基础设施等电子数据库，检索时间截至 2023 年 5 月。评估了新辅助治疗的晚期胃癌患者中 LG 与 OG 的短期和长期结局。使用随机效应模型始终评估具有 95%置信区间的效应量。该前瞻性方案已在 PROSPERO（CRD42022359126）中注册。
纳入了 18 项研究（2 项随机对照试验和 16 项队列研究），共 2096 名患者。其中，933 名患者接受 LG 治疗，1163 名患者接受 OG 治疗。在围手术期结局方面，LG 组术中出血量较少（MD=-65.15；P<0.0001）、肛门排气时间更快（MD=-0.56；P<0.0001）、开始液体摄入时间更早（MD=-0.42；P=0.02）、住院时间较短（MD=-2.26；P<0.0001）、总体并发症发生率较低（OR=0.70；P=0.002）和轻度并发症发生率较低（OR=0.69；P=0.006），但手术时间较长（MD=25.98；P<0.0001）。两组近端切缘、远端切缘、R1/R2 切除率、检出的淋巴结数量、拔除胃管和引流管的时间、主要并发症和其他特定并发症方面无显著差异。在生存结局方面，LG 和 OG 在总生存、无病生存和无复发生存方面无显著差异。
LG 可作为新辅助治疗的晚期胃癌患者的安全可行的治疗方法。然而，仍需要更多高质量的随机对照试验来进一步验证我们的研究结果。
