腹腔镜辅助与开腹手术治疗进展期胃癌安全性与有效性的Meta分析

目的系统评价腹腔镜辅助与开腹手术治疗进展期胃癌的安全性、有效性。方法检索PubMed、Embase、Cochrane library、中国知网、维普和万方等数据库2008年6月至2018年6月间的有关腹腔镜辅助和开腹手术治疗进展期胃癌的对比研究文献,对纳入研究行质量评价并提取数据资料,采用RevMan 5.3软件进行Meta分析。结果共纳入12项研究,其中英文文献7篇,中文文献5篇;2篇随机对照临床试验,10篇回顾性非随机对照研究;样本量合计4 199例,腹腔镜组2 118例,开腹组2 081例。Meta分析结果表明:与开腹组比较,腹腔镜组手术时间更长(WMD=26.32,P=0.01),失血量少(WMD=-109.84,P=0.00),淋巴结清扫数目、近端切缘距离及远端切缘距离差异无统计学意义(WMD值分别为1.2,-0.20,-0.01,均P>0.05),排气时间、进食时间、住院时间均显著优于开腹组(WMD值分别为-0.57,-0.67,-3.14,均P<0.05),术后并发症发生率更低(OR=0.75,P=0.00),1年总生存率、5年总生存率与开腹组比较差异均无统计学意义(OR分别为1.17,3.36,均P>0.05)。敏感性分析显示上述结果稳定;漏斗图分析未观察到明显发表偏倚。结论腹腔镜辅助进展期胃癌根治术安全可行,术中创伤更小,术后恢复更快,有望达到与开腹手术相同的根治效果。

Comparison of safety and efficacy between laparoscopic-assisted versus open radical gastrectomy for advanced gastric cancer:a Meta-analysis

Objective To systematic evaluate the safety and efficacy of laparoscopic-assisted versus open radical gastrectomy for advanced gastric cancer.Methods We retrieved the comparative studies on laparoscopic-assisted and open radical gastrectomy for advanced gastric cancer from the databases of PubMed,Embase,Cochrane Library,China Knowledge Network,VIP and Wanfang published from June 2008 to June 2018.The qualities of studies were evaluated and the relevant clinical data analyzed.Meta-analysis was performed with RevMan 5.3 software.Results A total of 12 studies were included,including 7 English articles,5 Chinese articles,2 randomized controlled trials(RCTs)and 10 respective non-controlled trials(RNTs).With a total sample size of 4 199,laparoscopic(n=2 118)and open(n=2 081)groups were designated.As compared with open gastrectomy group,laparoscopic-assisted gastrectomy group achieved a longer operative duration(WMD=26.32,P=0.01)and a smaller volume of blood loss(WMD=-109.84,P=0.00);no significant differences existed in number of harvested lymph node dissection,proximal resection margin or distal resection margin(WMD=1.2,-0.20,-0.01;all P >0.5).The time to flatus and oral intake and duration of hospitalization stay were significantly shorter than those of open group(WMD=-0.57,-0.67,-3.14;all P<0.05);the incidence of postoperative complications was lower(OR=0.75,P=0.00);1/5-year overall survival rate showed no significant inter-group difference(OR=1.17,3.36,P >0.05).Sensitivity analysis revealed the stability of the above results.And funnel plot indicated no significant publication bias.Conclusion With faster postoperative recovery,laparoscopic-assisted radical gastrectomy is both safe and feasible.It is expected to achieve a comparable radical efficacy as conventional open surgery.