内镜黏膜下剥离术与外科手术治疗早期胃癌的有效性及安全性的Meta分析

Endoscopic submucosal dissection and gastrectomy for early gastric cancer: a Meta-Analysis

目的内镜黏膜下剥离术(ESD)与外科手术是早期胃癌(EGC)的常用治疗方法,但其相关风险及获益目前仍存在争议,该研究旨在比较两种治疗方法在治疗EGC的有效性、安全性等方面的差异。方法检索1990年1月-2016年6月发表在Pubmed、CBM、Embase、Cochrane Library、中国知网数据库、维普数据库及万方数据库的有关ESD与外科手术治疗EGC对比研究的所有中英文文献,根据纳入和排除标准对搜索的相关文献进行二次筛选,并对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果总共有12篇文献符合纳入标准,且均为回顾性队列研究,共涉及4 331个研究对象。Meta分析的结果显示:ESD与外科手术相比,复发率[(22/2 586,0.85%)vs(6/1 134,0.53%),P=0.370]及5年生存率[(852/909,93.72%)vs(707/746,94.77%),P=0.340]差异无统计学意义,虽然外科手术在整块切除率方面稍高于ESD组[(99/99,100.00%)vs(95/103,92.23%),P=0.020],但是外科手术组的手术时间[标准化均数差(SMD)=-3.04,95%CI:-3.64^-2.45,P=0.000]及住院时间(SMD=-2.53,95%CI:-3.73^-1.32,P=0.000)比ESD组延长,且术后并发症增多[(45/816,5.50%)vs(101/686,14.72%),P=0.000]。结论对于EGC的治疗,两种治疗方法在复发率及5年生存率方面无明显差异,虽然ESD组在整块切除率上不及外科手术组,但其具有创伤小、手术时间短、术中及术后并发症少、住院时间短且恢复快等显著优势,可作为EGC的首选治疗方法。

Objective To compare the difference of the effects and safety of endoscopic submucosal dissection(ESD)and surgery for early gastric cancer.Methods We searched the Pubmed,CBM,Embase,Cochrane Library,CNKI,CQVIP and WanFang data from January1990to June2016studies comparing endoscopic resection withgastrectomy for treatment of early gastric cancer.We selected the eligible studies according the including andexcluding criteria.The quality of the included studies was assess using the Newcastle-Ottawa Scale(NOS),thenusing Revman5.3to make the Meta analysis.Result The meta-analysis enrolled12studies with4331patients,allof the studies were retrospectively analyzed.The result of the meta-analysis showed that there were no significantdifference regarding the recurrence rate[(22/2586,0.85%)vs(6/1134,0.53%),P=0.370]and five-year survival rate[(852/909,93.72%)vs(707/746,94.77%),P=0.340]between endoscopic resection and gastrectomy.Gastrectomy was associated with higher en bloc resection rate,which were100.00%and92.23%respectively.However,gastrectomy was also related to longer operative time(SMD=-3.04,95%CI:-3.64^-2.45,P=0.000)andhospital stay(SMD=-2.53,95%CI:-3.73^-1.32,P=0.000).The postoperative complication was also higher thanendoscopic,which were(45/816,5.50%)vs(101/686,14.72%)respectively.Conclusion There were no significantdifference regarding recurrence rate and five-year survival rate between endoscopic and gastrectomy.While the enbloc resection rate was lower than gastrectomy,endoscopic offers a shorter hospital stay,shorter operative time withminimal invasive and fewer operating and postoperative complications than gastrectomy.Endoscopic should berecommended as a standard treatment for early gastric cancer with indications.