腹腔镜辅助D2根治术治疗进展期胃癌安全性、有效性的Meta分析

Safety and Efficacy of Laparoscopy-assisted D2 Radical Gastrectomy in Treatment of Advanced Gastric Cancer:A Meta-analysis

目的系统分析腹腔镜辅助D2根治术治疗进展期胃癌的安全性和有效性。方法计算机检索Cochrane图书馆、PubMed、EMBase、CNKI数据库中有关腹腔镜辅助D2根治术与开腹D2根治术治疗进展期胃癌的前瞻性随机对照试验,检索时限为建库至2019年9月。由2名研究者独立提取纳入研究的试验设计、研究对象的特征、研究结果等,并采用RevMan 5.3软件进行Meta分析。结果按照入选标准有5项临床试验纳入研究,共2917例患者,其中腔镜组1463例、开腹组1454例。腔镜组手术时间长于开腹组(MD=31.46,95%CI 26.37~36.56,P<0.00001),术中出血量明显少于开腹组(MD=-15.40,95%CI-24.50^-6.29,P=0.0009),腔镜组术后第一次肛门排气时间、第一次进食清流食时间早于开腹组(MD=-0.19,95%CI-0.29^-0.08,P=0.0008;MD=-0.85,95%CI-1.05^-0.65,P<0.00001),住院时间短于开腹组(MD=-0.72,95%CI-1.19^-0.25,P=0.003),总体并发症发生率低于开腹组(RR=0.77,95%CI 0.63~0.93,P=0.006)。腔镜组与开腹组肿瘤大小比较差异无统计学意义(MD=-0.07,95%CI-0.23~0.09,P=0.39)。腔镜组淋巴结清扫数目少于开腹组(SMD=-0.91,95%CI-1.78^-0.05,P=0.04),腔镜组近端切缘距离小于开腹组(SMD=-0.38,95%CI-0.58^-0.17,P=0.0003),腔镜组与开腹组远端切缘距离比较差异无统计学意义(SMD=-0.13,95%CI-0.34~0.08,P=0.22)。结论在胃肠中心由经验丰富的外科医师对进展期胃癌实施腹腔镜辅助D2根治术是安全、有效的。

Objective To systematically analyze the safety and efficacy of laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer.Methods Cochrane library,PubMed,EMBase and CNKI were searched for prospective randomized controlled trials of laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer.The search time limit was from the database establishment to Sep.2019.Two authors cited the details about the designs of the trials,features of the participants and the outcomes from the included studies independently.The data were analyzed by RevMan 5.3 software.Results According to the selection criteria,5 clinical trials were included in the study,with a total of 2917 patients,including 1463 patients in the laparoscopy group and 1454 patients in the laparotomy group.The operation time of the laparoscopy group was longer than that of the laparotomy group(MD=31.46,95%CI 26.37-36.56,P<0.00001);the amount of intraoperative blood loss was significantly less than that of the laparotomy group(MD=-15.40,95%CI-24.50--6.29,P=0.0009);the time of the first anal exhaustion and the first clear liquid food in the laparoscopy group were earlier than that of the open group(MD=-0.19,95%CI-0.29--0.08,P=0.0008;MD=-0.85,95%CI-1.05--0.65,P<0.00001);the hospital stay was shorter than that of the laparotomy group(MD=-0.72,95%CI-1.19--0.25,P=0.003);the overall complication rate was lower than that of the open group(RR=0.77,95%CI 0.63-0.93,P=0.006).There was no significant difference in tumor size between the two groups(MD=-0.07,95%CI-0.23-0.09,P=0.39).The number of lymph node dissections in the laparoscopy group was less than that in the laparotomy group(SMD=-0.91,95%CI-1.78--0.05,P=0.04),and the distance of the proximal resection edge in the laparoscopy group was less than that in the laparotomy group(SMD=-0.38,95%CI-0.58--0.17,P=0.0003),while there was no significant difference in the distance of the distal resection edge between thetwo groups(SMD=-0.13,95%CI-0.34-0.08,P=0.22).Conclusion Laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer performed by experienced surgeons in the gastrointestinal center is safe and effective.