UNASSIGNED:本系统综述和荟萃分析的目的是比较腹腔镜远端胃切除术(LDG)和开腹远端胃切除术(ODG)对晚期胃癌(AGC)患者的短期和长期结果。
UNASSIGNED:已发表的包括不同胃切除术类型和混合肿瘤分期的荟萃分析数据阻止了LDG和ODG之间的准确比较。最近,将LDG与ODG进行比较的几项RCT包括专门用于远端胃切除术的AGC患者,报告D2淋巴结清扫术并更新长期结局。
未经授权:PubMed,Embase,和Cochrane数据库被搜索以鉴定RCTs用于比较晚期远端胃癌的LDG和ODG。短期手术结果和死亡率,发病率,并比较长期生存率。Cochrane工具和GRADE方法用于评估证据质量(Prospero注册ID:CRD42022301155)。
UNASSIGNED:共纳入了2,746例患者的5个随机对照试验。Meta分析显示术中并发症无显著差异,总体发病率,严重的术后并发症,R0切除,D2淋巴结清扫术,复发,3年无病生存期,术中输血,第一次流质饮食的时间,到了第一次行走的时间,远端边缘,再操作,死亡率,或在LDG和ODG之间重新接纳。LDG的手术时间明显更长[加权平均差(WMD)49.2分钟,p<0.05],而收集的淋巴结,术中失血,术后住院时间,时间到了第一次排气,LDG的近端边缘较低(WMD-1.3,p<0.05;WMD-33.6mL,p<0.05;WMD-0.7天,p<0.05;WMD-0.2天,p<0.05;WMD-0.4mm,p<0.05)。发现LDG后腹腔积液和出血较少。证据的确定性从中等到非常低。
UNASSIGNED:来自5个RCT的数据表明,LDG联合D2淋巴结清扫术治疗AGC的短期手术结果和长期生存率与ODG相似。可以得出结论,RCT应突出LDG用于AGC的潜在优势。
未经批准:PROSPERO,注册号CRD42022301155。
UNASSIGNED: The aim of this systematic
review and meta-analysis is to compare the short- and long-term outcomes of laparoscopic distal gastrectomy (LDG) with those of open distal gastrectomy (ODG) for patients with advanced gastric cancer (AGC) who exclusively underwent distal gastrectomy and D2 lymphadenectomy in randomized controlled trials (RCTs).
UNASSIGNED: Data in published meta-analyses that included different gastrectomy types and mixed tumor stages prevented an accurate comparison between LDG and ODG. Recently, several RCTs that compared LDG with ODG included AGC patients specifically for distal gastrectomy, with D2 lymphadenectomy being reported and updated with the long-term outcomes.
UNASSIGNED: PubMed, Embase, and Cochrane databases were searched to identify RCTs for comparing LDG with ODG for advanced distal gastric cancer. Short-term surgical outcomes and mortality, morbidity, and long-term survival were compared. The Cochrane tool and GRADE approach were used for evaluating the quality of evidence (Prospero registration ID: CRD42022301155).
UNASSIGNED: Five RCTs consisting of a total of 2,746 patients were included. Meta-analyses showed no significant differences in terms of intraoperative complications, overall morbidity, severe postoperative complications, R0 resection, D2 lymphadenectomy, recurrence, 3-year disease-free survival, intraoperative blood transfusion, time to first liquid diet, time to first ambulation, distal margin, reoperation, mortality, or readmission between LDG and ODG. Operative times were significantly longer for LDG [weighted mean difference (WMD) 49.2 min, p < 0.05], whereas harvested lymph nodes, intraoperative blood loss, postoperative hospital stay, time to first flatus, and proximal margin were lower for LDG (WMD -1.3, p < 0.05; WMD -33.6 mL, p < 0.05; WMD -0.7 day, p < 0.05; WMD -0.2 day, p < 0.05; WMD -0.4 mm, p < 0.05). Intra-abdominal fluid collection and bleeding were found to be less after LDG. Certainty of evidence ranged from moderate to very low.
UNASSIGNED: Data from five RCTs suggest that LDG with D2 lymphadenectomy for AGC has similar short-term surgical outcomes and long-term survival to ODG when performed by experienced surgeons in hospitals contending with high patient volumes. It can be concluded that RCTs should highlight the potential advantages of LDG for AGC.
UNASSIGNED: PROSPERO, registration number CRD42022301155.