背景:建议对胃癌进行分期腹腔镜检查以评估肿瘤的局部区域扩展并排除腹膜疾病。由于在优化程序的诊断准确性方面没有达成共识,我们旨在系统地回顾有关手术技术的文献,然后对胃癌患者进行腹腔灌洗液评估。具体来说,我们试图说明手术和细胞学评估的最常见特征.
方法:本研究是根据系统评价和荟萃分析(PRISMA)的首选报告项目进行的。本系统综述的方案已在PROSPERO数据库(CRD:42022306746)上注册。2022年9月,使用Embase进行了搜索,Medline所有,Cochrane中央对照试验登记册和WebofScience核心收藏。
结果:搜索确定了1632项关于分期腹腔镜检查的研究和2190项关于腹膜液评估的研究。共纳入212项研究。在65%的研究中,开放哈森是进入腹膜腔的首选方法,随后在52%的报告中建立了10-12mmHg的气腹。大多数情况下,患者仰卧位(70%),而30°范围和三个端口用于顺时针评估腹膜腔(72%,77%,85%,分别)。右上腹部和左上腹部是腹腔镜探查的主要区域(均为65%),其次是原发肿瘤区域(54%),肝脏和骨盆(均为30%),小肠和脾脏(19%和17%,分别)。腹腔灌洗和抽吸的区域仅限于骨盆(50%),其次是右和左上腹象限(37.5%和50%,分别)。没有研究比较不同的手术技术或腹水/液体分析方法。
结论:本研究表明,胃癌患者的腹腔镜分期和腹膜液评估技术存在高度异质性。需要进一步的研究和倡议,以就程序的标准化达成共识。
BACKGROUND: Staging laparoscopy for gastric cancer is recommended to assess the tumor\'s locoregional extension and exclude peritoneal disease. As there is no consensus on optimizing the procedure\'s diagnostic accuracy, we aimed to systematically
review the literature on operative techniques, followed by peritoneal lavage fluid assessment in gastric cancer patients. Specifically, we sought to indicate the most common characteristics of the procedure and cytological evaluation.
METHODS: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol for this systematic
review was registered on PROSPERO database (CRD: 42022306746). On September 2022, a search was carried out using Embase, Medline ALL, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection.
RESULTS: The search identified 1632 studies on staging laparoscopy and 2190 studies on peritoneal fluid assessment. Some 212 studies were included. Open Hasson was the method of choice in accessing the peritoneal cavity in 65% of the studies, followed by establishing a pneumoperitoneum at 10-12 mmHg in 52% of reports. Most frequently, the patient was positioned supine (70%), while a 30° scope and three ports were used to assess the peritoneal cavity clockwise (72%, 77%, and 85%, respectively). Right and left upper abdomen quadrants were the predominant area of laparoscopic exploration (both 65%), followed by the primary tumor region (54%), liver and pelvis (both 30%), and small bowel and spleen (19% and 17%, respectively). Regions of peritoneal lavage and aspiration were limited to the pelvis (50%), followed by right and left upper abdomen quadrants (37.5% and 50%, respectively). No studies compared different methods of operative techniques or analysis of ascites/fluid.
CONCLUSIONS: This study indicates a high heterogeneity in the technique of staging laparoscopy and peritoneal fluid assessment in gastric cancer patients. Further research and initiatives to reach a consensus on the standardization of the procedure are warranted.