腹腔镜辅助与传统开放胃癌根治术治疗老年胃癌患者安全性及疗效比较的meta分析

Safety and efficacy of laparoscopic-assisted gastrectomy versus conventional open gastrectomy for elderly patients with gastric cancer: a meta-analysis

目的系统评价腹腔镜辅助胃癌根治术(LAG)与传统开放胃癌根治术(COG)治疗老年胃癌患者的安全性及疗效。方法计算机检索Pubmed、EMBASE、Web of Science、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库及维普数据库中的有关LAG与COG治疗老年胃癌患者疗效比较的文献,采用Rev Man 5.2软件行meta分析。结果最终纳入10篇病例对照研究,累计样本量为1 522例,其中观察组757例,对照组765例。meta分析结果显示:对于老年胃癌患者,与COG比较,LAG的术中出血量少[MD=–121.12,95%CI为(–179.93,–62.31),P<0.000 1],术中淋巴结清扫数量多[MD=1.62,95%CI为(0.60,2.65),P=0.002],术后首次下床活动时间[SMD=–2.58,95%CI为(–4.58,–0.58),P=0.01]、术后肠道功能恢复时间[SMD=–0.85,95%CI为(–1.20,–0.51),P<0.000 01]和术后首次经口进食时间[MD=–0.90,95%CI为(–1.27,–0.52),P<0.000 01]早,术后住院时间短[MD=–4.03,95%CI为(–5.62,–2.44),P<0.000 01],术后总体并发症发生率[OR=0.49,95%CI为(0.38,0.64),P<0.000 01]、手术相关并发症发生率[OR=0.54,95%CI为(0.39,0.74),P=0.000 1]、切口并发症发生率[OR=0.42,95%CI为(0.22,0.81),P=0.010]及呼吸系统并发症发生率[OR=0.60,95%CI为(0.38,0.95),P=0.03]均较低,但2组患者的手术时间[MD=8.36,95%CI为(–10.97,27.69),P=0.40]和术后吻合口漏发生率[OR=0.60,95%CI为(0.27,1.31),P=0.20]比较差异均无统计学意义。结论对老年胃癌患者,LAG与COG同样安全及可行,且LAG在减少术中出血量及保证术中淋巴结清扫数量方面具有明显优势,具有创伤小、术后住院时间短、术后总体并发症发生率低等近期疗效优势。

Objective To evaluate the safety and efficacy of laparoscopic-assisted gastrectomy （LAG） comparing with conventional open gastrectomy （COG） in elderly patients with gastric cancer. Methods Databases included PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP were searched to collect the case-control studies about LAG versus COG for elderly patients with gastric cancer, and the searched time was from inception to May 2017. Then meta-analysis was performed by using RevMan 5.2 software. Results Finally, ten case-control studies included 1 522 patients were enrolled. There were 757 patients in observation group （underwent LAG） and 765 patients in control group （underwent COG）. Results of meta-analysis showed that： the observation group was associated with less intraoperative blood loss [MD=–121.12, 95% CI was （–179.93, –62.31）, P〈0.000 1], more harvested lymph nodes [MD=1.62, 95% CI was （0.60, 2.65）, P=0.002], shorter time to the first ambulation [SMD=–2.58, 95% CI was（–4.58, –0.58）, P=0.01], shorter the postoperative intestinal function recovery time [SMD=–0.85, 95% CI was （–1.20, –0.51）, P〈0.000 01], shorter the time of oral intake [MD=–0.90, 95% CIwas （–1.27, –0.52）, P〈0.000 01], shorter hospital stay [MD=–4.03,95% CI was （–5.62, –2.44）, P〈0.000 01], lower incidences of overall postoperative complications [OR=0.49, 95% CI was （0.38,0.64）, P〈0.000 01], surgical-related complications [OR=0.54, 95% CI was （0.39, 0.74）, P=0.000 1], incision relatedcomplications [OR=0.42, 95% CI was （0.22, 0.81）, P=0.010], and respiratory complications [OR=0.60, 95% CI was （0.38, 0.95）, P=0.03], but there was no significant difference on the operative time [MD=8.36, 95% CI was （–10.97, 27.69）, P=0.40] and incidence of anastomotic fistula [OR=0.60, 95% CI was （0.27, 1.31）, P=0.20]. Conclusions The available evidences suggest that LAG is equally safe and feasible compared with COG, it has a significant advantages in reducing intraoperative blood loss and ensuring the number of lymph node dissected during surgery, with less trauma, shorter postoperative hospital stay, lower overall postoperative complications rate, and other short-term efficacy advantages.