腹腔镜与开腹进展期胃癌D2根治术远期疗效的Meta分析

Laparoscopic versus open D2 gastrectomy for advanced gastric cancer： A meta-analysis on long-term outcomes

目的 系统评价腹腔镜与开腹进展期胃癌D2根治术的远期临床疗效。方法 以胃肿瘤、腹腔镜、胃切除术、远期疗效、Meta分析、Gastric neoplasms、Laparoscopy、 Gastrectomy、Long-term outcomes、Meta-analysis为检索词，检索发表于PubMed、EMBASE、Medline、Cochrane Library、万方数据库、中国期刊全文数据库、中国生物医学期刊文献数据库及维普数据库中比较腹腔镜与开腹进展期胃癌D2根治术临床疗效的文献，检索时间为2002年1月-2016年10月。按预设标准进行筛选并进行质量评价，提取数据后用RevMan5．2软件对两组患者的远期生存及复发情况进行Meta分析。生存率及复发率采用OR及95%CI表示。采用I2检验对异质性进行分析。结果 有15项对照研究共计4 053例患者纳入分析，其中腹腔镜组2 091例，开腹组1962例。Meta分析结果显示，腹腔镜组与开腹组的3年总体生存率（OR=1.00，95%CI：0.83-1.20，P=0.98），5年总体生存率（OR=1.14，95%CI：0.95-1.36，P=0.15），5年无病生存率（OR=1.13，95%CI：0.93-1.39，P=0.22），复发率差异均无统计学意义（OR=0.96，95%CI：0.79-1.18，P=0.71）。结论 腹腔镜进展期胃癌D2根治术可以达到与开腹手术相当的远期疗效。

Objective To evaluate the longterm clinical outcomes between laparoscopic gastrectomy and open gastrectomy with D2 lymph dissection for advanced gastric cancer. Methods Clinical studies that compared clinical outcomes of laparoscopic gastrectomy and open gastrectomy for advanced gastric cancer were searched from PubMed, EMBASE, Medline, Cochrane Library, WanFang, CNKI, CMCC and VIP database with the ＂Gastric neoplasms＂＂Laparoscopy＂＂Gastrectomy＂＂Longterm outcomes＂＂Metaanalysis＂ between Jan. 2002 and Oct. 2016. Data of longterm survival and recurrence were analyzed by using of RevMan 5.2 software. Survival data were present by the odds ratio（OR） and 95%CI. The heterogeneity of the data was analyzed using the I2 test. Results Fifteen studies including 4,053 cases were enrolled. There were 2,091 patients in LG group and 1,962 patients in the open gastrectomy group. There was no significant difference in the 3year overall survival rate（OR=1.00, 95%CI： 0.83-1.20, P=0.98）, 5year overall survival rate（OR=1.14, 95%CI： 0.95-1.36, P=0.15）, 5year diseasefree survival rate（OR=1.13, 95%CI： 0.93-1.39, P=0.22）and cancer recurrence rate（OR=0.96, 95%CI： 0.79-1.18, P=0.71） between the patients treated with laparoscopic gastrectomy, or open gastrectomy （P〉0.05）. Conclusion Laparoscopic gastrectomy with D2 lymph dissection for advanced gastric cancer has similar longterm outcomes as compared to open gastrectomy.