Granieri Stefano, Sileo Annaclara, Altomare Michele, Frassini Simone, Gjoni Elson, Germini Alessandro, Bonomi Alessandro, Akimoto Eigo, Wong Chun Lam, Cotsoglou Christian
General Surgery Unit, ASST Brianza-Vimercate Hospital, 20871 Vimercate, Italy.
General Surgery Residency Program, University of Milan, 20122 Milan, Italy.
Cancers (Basel). 2023 Dec 31;16(1):199. doi: 10.3390/cancers16010199.
Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25-4.86; 95%; = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.
全胃系膜切除术（CME）已被提倡用于更广泛地清扫淋巴结，并降低局部区域复发率。本研究旨在分析与标准D2根治性胃切除术相比，行CME的D2根治性胃切除术的短期疗效。根据Cochrane推荐意见，截至2023年7月2日进行了一项系统的文献综述（PROSPERO编号：CRD42023443361）。主要结局指标以平均差（MD）和95%置信区间（CI）表示，为清扫淋巴结（LN）的数量。采用随机效应模型进行均值和二元结局的Meta分析，以评估异质性。使用RoB 2和ROBINS-I工具评估纳入研究的偏倚风险。纳入了13项研究，共2009例患者，结果显示CME组清扫的LN平均数量显著更高（MD：2.55；95%CI：0.25 - 4.86；P = 0.033）。CME组术中失血量也显著更低，住院时间更短，手术时间更短。三项研究显示存在严重的偏倚风险，研究间异质性大多为中度或高度。行CME的根治性胃切除术可能提供一种安全且更彻底的淋巴结清扫术，但该技术在西方的长期疗效及适用性仍有待证实。
