腹腔镜对比开腹手术治疗老年进展期胃癌疗效和安全性的Meta分析

Meta-analysis of the efficacy and safety of laparoscopic versus open surgery for elderly patients with advanced gastric cancer

目的通过对腹腔镜与开腹手术治疗老年进展期胃癌的相关临床研究进行Meta分析,比较2种治疗方式的疗效,并评估腹腔镜手术治疗老年进展期胃癌的可行性、安全性和有效性。方法从数据库建立到2022年6月,在PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献(CBM)数据库中检索数据。使用Review Manager 5.3软件绘制森林图进行Meta分析,发表偏倚用漏斗图评估,采用Stata软件通过Egger检测评估发表偏倚。结局指标包括手术时间、术中出血量、淋巴结清扫数量、术后首次肛门排气时间、术后首次进食时间、术后首次下地时间、住院时间、术后总体并发症发生率、术后切口感染发病率、肺部感染发病率、术后肠梗阻发病率和吻合口漏发病率。结果共有11篇文献符合研究标准,包括2篇随机对照试验和9篇回顾性研究,共纳入样本量1081例,其中腹腔镜组519例,开腹组562例。Meta分析结果显示,与开腹组相比,腹腔镜组术中出血量较少(MD=-104.21,95%CI:-132.54~-75.89,P<0.00001)、术后首次肛门排气时间较早(MD=-1.90,95%CI:-2.19~-1.49,P<0.00001)、术后首次进食时间较早(MD=-1.92,95%CI:-2.48~-1.35,P<0.00001)、术后首次下地时间较早(MD=-2.89,95%CI:-3.32~-2.45,P<0.00001)、住院时间较短(MD=-6.08,95%CI:-7.20~-4.97,P<0.00001)、术后总体并发症发生率较低(OR=0.40,95%CI:0.29~0.56,P<0.00001)、术后切口感染发病率较低(OR=0.33,95%CI:0.17~0.67,P=0.002)、肺部感染发病率较低(OR=0.39,95%CI:0.22~0.69,P=0.001)、手术时间较长(MD=30.35,95%CI:14.34~46.35,P=0.0002),差异均有统计学意义(P<0.05)。两组清扫淋巴结数量(MD=-0.52,95%CI:-1.76~0.73,P=0.41)、术后肠梗阻发病率(OR=0.38,95%CI:0.13~1.13,P=0.08)和吻合口漏发病率(OR=0.41,95%CI:0.16~1.06,P=0.07)差异无统计学意义。结论腹腔镜胃癌根治术对于老年进展期胃癌患者安全、可行的,在疗效和根治性治疗方面不亚于甚至优于开腹胃癌根治术。

Objective To probe the security and effectiveness of laparoscopic mustard surgery in elderly patients with advanced gastric cancer and that of open label laparoscopic mustard surgery by Meta-analysis.Methods From database creation to June 2022,PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang database,VIP database and Chinese Biomedical Literature(CBM)database were searched.RevMan5.3 software was used to make forest maps for Meta-analysis,and funnel plot was used to evaluate publication bias,and Egger was used to detect whether there was publication bias.The operation time,intraoperative blood loss,number of lymph nodes remove,time to first flatus,time to first oral diet,time to ambulation,length of hospital stay,and overall postoperative complications rate,incidence of postoperative wound infection,incidence of pulmonary infection,incidence of postoperative intestinal obstruction and incidence of anastomotic leakage were included and analyzed.Results A total of 11 contributions were submitted,including 2 randomized controlled trials and 9 retrospective studies.The total number of patients included in this study was 1081,including 519 in the abdominal group and 562 in the open group.Results showed that the intraperitoneal group had less bleeding compared to open surgery(MD=-104.21,95%CI:-132.54--75.89,P<0.00001),earlier first flatus(MD=-1.90,95%CI:-2.19--1.49,P<0.00001),the first time to oral diet was earlier(MD=-1.92,95%CI:-2.48--1.35,P<0.00001),the time of first landing after operation was earlier(MD=-2.89,95%CI:-3.32--2.45,P<0.00001),the length of hospital stay was shorten(MD=-6.08,95%CI:-7.20--4.97,P<0.00001),a lower overall postoperative complication rate(OR=0.40,95%CI:0.29-0.56,P<0.00001),the incidence of postoperative incision infection was lower(OR=0.33,95%CI:0.17-0.67,P=0.002),the incidence of pulmonary infection was lower(OR=0.39,95%CI:0.22-0.69,P=0.001),the operation time was longer(MD=30.35,95%CI:14.34-46.35,P=0.0002),and the differences were statistically significant(P<0.05).There are no statistical significance in the number of lymph nodes remove(MD=-0.52,95%CI:-1.76-0.73,P=0.41),the incidence of postoperative intestinal obstruction(OR=0.38;95%CI:0.13-1.13;P=0.08)and the incidence of anastomotic leakage(OR=0.41,95%CI:0.16-1.06,P=0.07)between two groups.Conclusions Compared with open radical gastrectomy,laparoscopic radical gastrectomy is safe and feasible for elderly patients with advanced gastric cancer as well,and even better than open radical gastrectomy in curative effect and radical treatment.