胃癌根治术联合脾脏切除治疗胃癌的Meta分析

Effect of radical surgery combined with splenectomy in treatment of gastric cancer:a Meta-analysis

目的评估胃癌根治术（radical gastrectomy,RG）联合脾脏切除术（splenectomy,SE）治疗进展期胃癌的长期效果。方法以Pub Med、Cochrane、Web of knowledge、Ovid Springer Link、中国知网、万方、维普为数据源,检索相关文献,采用Rev Man对切脾与保脾的RG随机对照试验（RCT）进行Meta分析,结局变量为患者5年生存率、手术操作相关并发症、术后30 d死亡率。结果符合纳入标准的RCT研究共5篇,包括1 344例病例,切脾组588例,保脾组756例,切脾组与保脾组5年生存率比较,差异无统计学意义（OR=0.80,95%CI：0.60-1.06,P〉0.05）,灵敏性分析切脾组患者5年生存率低于保脾组（OR=0.72,95%CI：0.53-0.97,P〈0.05）;切脾组操作相关并发症发生率明显高于保脾组（OR=2.51,95%CI：1.90-3.33,P〈0.05）,两组术后30 d死亡率比较差异无统计学意义（OR=1.57,95%CI：0.59-4.23,P〉0.05）。结论 SE并不能有效改善患者预后,反而增加了术后并发症的发生,暂不推荐SE作为进展期胃癌的常规术式。

Objective To evaluate the effect of radical gastrectomy（ RG） combined with splenectomy（ SE） on longterm outcomes of patients with gastric cancer by a Meta-analysis. Methods A search of databases to identify randomized controlled trials（ RCTs） in Pub Med,Cochrane,Web of knowledge,Ovid,Springer Link,CNKI,Wan Fang data were performed. Outcome measures were survival rate,operation-related events,postoperative mortality（ 30 days）. The Meta-analysis was performed by Rev Man 5. 3. Results Five RCT studies met the inclusion criteria,including 588 patients in SE group and 756 patients in splean-preserving group. There was no significant difference in the 5-year overall survival rate between SE group and spleen-preserving group（ OR = 0. 80,95% CI： 0. 60- 1. 06,P 0. 05）. Sensitivity analysis indicated the 5-year overall survival rate in SE group was lower than that in spleen-preserving group（ OR = 0. 72,95% CI：0. 53 - 0. 97,P 0. 05）; The complications rate in SE group was higher than that in spleen-preserving group（ OR = 2. 51,95% CI： 1. 90 - 3. 33,P〈 0. 05）; There was no significant difference in postoperative mortality（ 30 days） between the two groups（ OR = 1. 57,95% CI： 0. 59 - 4. 23,P 〉0. 05）. Conclusion SE did not show a beneficial effect on survival rate compared with splenic preservation. Routinely performing SE should not be recommended.