腹腔镜与开腹进展期胃癌全胃切除术远期疗效的meta分析

Meta-analysis of the long-term effect of laparoscopic and open gastrectomy for advanced gastric cancer

目的:系统评价腹腔镜与开腹进展期胃癌全胃切除术的远期疗效。方法:以进展期胃癌、腹腔镜、开腹、生存率、Total gastrectomy、Advanced gastric cancer、Survival rate为检索词,检索发表于PubMed、Embase、Web of Science等英文数据库,以及万方医学网数据库、中国知网(CNKI)等中文数据库的文献,提取有关腹腔镜与开腹进展期胃癌全胃切除术进行对比研究的文献,检索时间为2013~2019年。对提取的文献按预设标准进行筛选并进行质量评价,提取两组患者远期生存与复发情况,采用RevMan 5.3软件进行meta分析。结果:共检索14篇文献,其中2篇因存在数据缺失未能入选,共纳入12篇、共计2674例患者,其中腹腔镜组970例,开腹组1704例。meta结果显示,腹腔镜组与开腹组5年总体生存率(OR=1.12,95%CI:0.91~1.36,P=0.29),3年无病生存率(OR=0.84,95%CI:0.55~1.30,P=0.44),5年无病生存率(OR=1.14,95%CI:0.91~1.41,P=0.25),复发率(OR=0.48,95%CI:0.19~1.24,P=0.13),差异均无统计学意义。结论:腹腔镜进展期胃癌全胃切除术可达到与开腹手术相当的远期疗效。

Objective:To evaluate the long-term effect of laparoscopic and open gastrectomy for advanced gastric cancer.Methods:The literatures published in PubMed,Embase,Web of Science and other English databases,Wanfang medical network database,CNKI and other Chinese databases were searched with the key words of advanced gastric cancer,laparoscopy,laparotomy,total gastrectomy,survival rate.These literatures compared the laparoscopic and open total gastrectomy of advanced gastric cancer,and the retrieval time was from 2013 to 2019.The extracted literature was screened and evaluated according to the preset criteria.The long-term survival and recurrence of the two groups were extracted and meta-analysis was made with RevMan 5.3 software.Results:There were 14 related research literatures in total,two of which were not selected due to data deficiency,so a total of 12 related researches were selected,a total of 2674 patients were included in this analysis,including 970 in the laparoscopic group and 1704 in the open group.Meta results showed that there was no significant difference in 5-year overall survival rate(OR=1.12,95%CI:0.91-1.36,P=0.29),3-year disease-free survival rate(OR=0.84,95%CI:0.55-1.30,P=0.44),5-year disease-free survival rate(OR=1.14,95%CI:0.91-1.41,P=0.25)or recurrence rate(OR=0.48,95%CI:0.19-1.24,P=0.13).Conclusions:Laparoscopic total gastrectomy for advanced gastric cancer has similar long-term outcomes as compared to open gastrectomy.