目标:目前,对于超高龄(年龄>80岁)患者是否适合腹腔镜手术,目前尚无共识.本研究旨在分析超高龄胃癌(GC)患者腹腔镜胃切除术的近期疗效和肿瘤预后。
方法:遵循PRISMA和AMSTAR-2指南,我们搜索了科学网,Embase,科克伦图书馆,和Pubmed数据库从开始到2024年5月,并进行了荟萃分析。回顾了所有已发表的研究,这些研究探讨了腹腔镜与开腹胃切除术在超老年GC患者中的手术效果和肿瘤预后。使用RevMan5.3进行统计分析。
结果:共检索了1,085项研究,其中八个被纳入荟萃分析,包括807名年龄>80岁的GC患者。Meta分析显示,与开腹胃切除术相比,接受腹腔镜胃切除术的GC>80岁患者的手术时间更长(加权平均差异[WMD]=30.48,p<0.001),术中出血量少(WMD=-166.96,P<0.001),术后排气时间较短(WMD=-0.83,p<0.001),住院时间较短(WMD=-0.78,p<0.001),总体并发症较少(几率[OR]=0.54,p=0.003),5年总生存率(OR=1.66,p=0.03)和疾病特异性生存率(OR=3.23,p<0.001)。此外,腹腔镜胃切除术对淋巴结清扫数目无明显影响,胃癌D2根治术率,术后主要并发症,或术后肺炎。
结论:与开腹胃切除术相比,年龄>80岁接受腹腔镜胃切除术的GC患者可能有更好的短期预后.年龄不应成为微创手术的禁忌症。
OBJECTIVE: Currently, there is no consensus regarding whether super-elderly (aged > 80 years) patients are suitable candidates for laparoscopic surgery. This study aimed to analyse the short-term outcomes and oncological prognosis of laparoscopic gastrectomy in super-elderly patients with gastric cancer (GC).
METHODS: Following PRISMA and AMSTAR-2 guidelines, we searched the Web of Science, Embase, Cochrane Library, and Pubmed databases from inception until May 2024 and performed a meta-analysis. All published studies exploring the surgical outcomes and oncological prognosis of laparoscopic versus open gastrectomy in super-elderly patients with GC were reviewed. Statistical analyses were performed using RevMan 5.3.
RESULTS: A total of 1,085 studies were retrieved, eight of which were included in the meta-analysis, comprising 807 patients > 80 years of age with GC. The meta-analysis showed that compared with open gastrectomy, patients with GC > 80 years old who underwent laparoscopic gastrectomy had a longer operative time (weighted mean difference [WMD] = 30.48, p < 0.001), less intraoperative blood loss (WMD = -166.96, P < 0.001), shorter postoperative exhaust time (WMD =-0.83, p < 0.001), shorter length of stay (WMD = -0.78, p < 0.001), fewer overall complications (Odds ratio [OR] = 0.54, p = 0.003), higher 5-year overall survival rate (OR = 1.66, p = 0.03) and disease-specific survival rate (OR = 3.23, p < 0.001). Furthermore, laparoscopic gastrectomy did not significantly affect the number of lymph node dissections, the rate of D2 radical gastrectomy, major postoperative complications, or postoperative pneumonia.
CONCLUSIONS: Compared to open gastrectomy, patients with GC aged > 80 years who underwent laparoscopic gastrectomy may have better short-term outcomes. Age should not be a contraindication for minimally invasive surgery.