AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissecti...AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage.RESULTS: There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P > 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no signifi cant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had signifi cantly less blood loss, but a longer operation time (P < 0.001). The morbidity of the LAG group was 9.9%, which was not signifi cantly different from the OG group (7.7%) (P = 0.587). The mortality was zero in both groups. CONCLUSION: Laparoscopic D2 dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG.展开更多
Background:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer,but the effects on safety and survival are still controversial.The objective of this meta-analysis was to compare the overall sur...Background:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer,but the effects on safety and survival are still controversial.The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery(NACS)and surgery alone(SA)for locally advanced gastric cancer.Methods:Databases(PubMed,Embase,Web of Science,Cochrane Library,and Google Scholar)were explored for relative studies from January 2000 to January 2021.The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale,respectively.The Review Manager software(version 5.3)was used to perform this meta-analysis.The overall survival was evaluated as the primary outcome,while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.Results:Twenty studies,including 1420 NACS cases and 1942 SA cases,were enrolled.The results showed that there were no significant differences in overall survival(P=0.240),harvested lymph nodes(P=0.200),total complications(P=0.080),and 30-day post-operative mortality(P=0.490)between the NACS and SA groups.However,the NACS group was associated with a longer operation time(P<0.0001),a higher R0 resection rate(P=0.003),less reoperation(P=0.030),and less anastomotic leakage(P=0.007)compared with SA group.Conclusions:Compared with SA,NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage.While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.展开更多
Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is su...Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results:This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.Conclusions:The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.展开更多
基金Supported by The Capital Medical Development Research Fund, No. 2009-2093
文摘AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage.RESULTS: There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P > 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no signifi cant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had signifi cantly less blood loss, but a longer operation time (P < 0.001). The morbidity of the LAG group was 9.9%, which was not signifi cantly different from the OG group (7.7%) (P = 0.587). The mortality was zero in both groups. CONCLUSION: Laparoscopic D2 dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG.
基金the Capital Medical Development and Research Foundation(No.2018-2-2153)the National Natural Science Foundation of China(Nos.82073357,81672439,81272766,and 81450028)the Beijing Natural Science Foundation(No.7162039).
文摘Background:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer,but the effects on safety and survival are still controversial.The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery(NACS)and surgery alone(SA)for locally advanced gastric cancer.Methods:Databases(PubMed,Embase,Web of Science,Cochrane Library,and Google Scholar)were explored for relative studies from January 2000 to January 2021.The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale,respectively.The Review Manager software(version 5.3)was used to perform this meta-analysis.The overall survival was evaluated as the primary outcome,while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.Results:Twenty studies,including 1420 NACS cases and 1942 SA cases,were enrolled.The results showed that there were no significant differences in overall survival(P=0.240),harvested lymph nodes(P=0.200),total complications(P=0.080),and 30-day post-operative mortality(P=0.490)between the NACS and SA groups.However,the NACS group was associated with a longer operation time(P<0.0001),a higher R0 resection rate(P=0.003),less reoperation(P=0.030),and less anastomotic leakage(P=0.007)compared with SA group.Conclusions:Compared with SA,NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage.While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.
基金grants from the National Natural Science Foundation of China(No.81672439)the CapitaPs Funds for Health Improvement and Research(No.CFH 2018-2-2153)Beijing Municipal Administration of Hospitals Incubating Program(No.PX2016018).
文摘Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results:This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.Conclusions:The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.