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Abstract：
BACKGROUND: Outcomes of laparoscopic surgery in advanced gastric cancer patients who received neoadjuvant therapy represent a controversial issue. We performed an updated meta-analysis to evaluate the perioperative and long-term survival outcomes of laparoscopic gastrectomy (LG) versus conventional open gastrectomy (OG) in this subset of patients.
METHODS: Electronic databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were comprehensively searched up to May 2023. The short-term and long-term outcomes of LG versus OG in advanced gastric cancer patients undergoing neoadjuvant therapy were evaluated. Effect sizes with 95% confidence intervals were always assessed using random-effects model. The prospective protocol was registered with PROSPERO (CRD42022359126).
RESULTS: Eighteen studies (2 randomized controlled trials and 16 cohort studies) involving 2096 patients were included. In total, 933 patients were treated with LG and 1163 patients were treated with OG. In perioperative outcomes, LG was associated with less estimated blood loss (MD = - 65.15; P < 0.0001), faster time to flatus (MD = - 0.56; P < 0.0001) and liquid intake (MD = - 0.42; P = 0.02), reduced hospital stay (MD = - 2.26; P < 0.0001), lower overall complication rate (OR = 0.70; P = 0.002) and lower minor complication rate (OR = 0.69; P = 0.006), while longer operative time (MD = 25.98; P < 0.0001). There were no significant differences between the two groups in terms of proximal margin, distal margin, R1/R2 resection rate, retrieved lymph nodes, time to remove gastric tube and drainage tube, major complications and other specific complications. In survival outcomes, LG and OG were not significantly different in overall survival, disease-free survival and recurrence-free survival.
CONCLUSIONS: LG can be a safe and feasible technique for the treatment of advanced gastric cancer patients receiving neoadjuvant therapy. However, more high-quality randomized controlled trials are still needed to further validate the results of our study.
METHODS: Electronic databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were comprehensively searched up to May 2023. The short-term and long-term outcomes of LG versus OG in advanced gastric cancer patients undergoing neoadjuvant therapy were evaluated. Effect sizes with 95% confidence intervals were always assessed using random-effects model. The prospective protocol was registered with PROSPERO (CRD42022359126).
RESULTS: Eighteen studies (2 randomized controlled trials and 16 cohort studies) involving 2096 patients were included. In total, 933 patients were treated with LG and 1163 patients were treated with OG. In perioperative outcomes, LG was associated with less estimated blood loss (MD = - 65.15; P < 0.0001), faster time to flatus (MD = - 0.56; P < 0.0001) and liquid intake (MD = - 0.42; P = 0.02), reduced hospital stay (MD = - 2.26; P < 0.0001), lower overall complication rate (OR = 0.70; P = 0.002) and lower minor complication rate (OR = 0.69; P = 0.006), while longer operative time (MD = 25.98; P < 0.0001). There were no significant differences between the two groups in terms of proximal margin, distal margin, R1/R2 resection rate, retrieved lymph nodes, time to remove gastric tube and drainage tube, major complications and other specific complications. In survival outcomes, LG and OG were not significantly different in overall survival, disease-free survival and recurrence-free survival.
CONCLUSIONS: LG can be a safe and feasible technique for the treatment of advanced gastric cancer patients receiving neoadjuvant therapy. However, more high-quality randomized controlled trials are still needed to further validate the results of our study.
摘要：
背景：接受新辅助治疗的晚期胃癌患者的腹腔镜手术结果是一个有争议的问题。我们进行了一项更新的荟萃分析，以评估腹腔镜胃切除术（LG）与传统开腹胃切除术（OG）的围手术期和长期生存结果。
方法：电子数据库，包括PubMed，Embase,WebofScience,截至2023年5月，全面搜索了Cochrane中央对照试验登记册和中国国家知识基础设施。对接受新辅助治疗的晚期胃癌患者进行LG和OG的短期和长期结果进行评估。始终使用随机效应模型评估具有95％置信区间的效应大小。前瞻性方案在PROSPERO（CRD42022359126）注册。
结果：共纳入18项研究（2项随机对照试验和16项队列研究），涉及2096例患者。总的来说,933例患者接受LG治疗，1163例患者接受OG治疗。在围手术期结果中，LG与较少的估计失血相关（MD=-65.15；P<0.0001），更快的排气时间（MD=-0.56;P<0.0001）和液体摄入量（MD=-0.42;P=0.02），住院时间缩短（MD=-2.26；P<0.0001），总体并发症发生率较低（OR=0.70；P=0.002），次要并发症发生率较低（OR=0.69；P=0.006），而手术时间较长(MD=25.98;P<0.0001)。两组间在近端切缘方面无显著差异,远端边缘，R1/R2切除率,取出淋巴结,拔除胃管和引流管的时间，主要并发症和其他特定并发症。在生存结果中，LG和OG在总体生存率上没有显着差异，无病生存率和无复发生存率。
结论：LG是治疗晚期胃癌新辅助治疗的安全可行的技术。然而,仍需要更多高质量的随机对照试验来进一步验证我们的研究结果.
方法：电子数据库，包括PubMed，Embase,WebofScience,截至2023年5月，全面搜索了Cochrane中央对照试验登记册和中国国家知识基础设施。对接受新辅助治疗的晚期胃癌患者进行LG和OG的短期和长期结果进行评估。始终使用随机效应模型评估具有95％置信区间的效应大小。前瞻性方案在PROSPERO（CRD42022359126）注册。
结果：共纳入18项研究（2项随机对照试验和16项队列研究），涉及2096例患者。总的来说,933例患者接受LG治疗，1163例患者接受OG治疗。在围手术期结果中，LG与较少的估计失血相关（MD=-65.15；P<0.0001），更快的排气时间（MD=-0.56;P<0.0001）和液体摄入量（MD=-0.42;P=0.02），住院时间缩短（MD=-2.26；P<0.0001），总体并发症发生率较低（OR=0.70；P=0.002），次要并发症发生率较低（OR=0.69；P=0.006），而手术时间较长(MD=25.98;P<0.0001)。两组间在近端切缘方面无显著差异,远端边缘，R1/R2切除率,取出淋巴结,拔除胃管和引流管的时间，主要并发症和其他特定并发症。在生存结果中，LG和OG在总体生存率上没有显着差异，无病生存率和无复发生存率。
结论：LG是治疗晚期胃癌新辅助治疗的安全可行的技术。然而,仍需要更多高质量的随机对照试验来进一步验证我们的研究结果.
