■关于脾切除术(SP)和脾保存在胃癌外科治疗中的相对优势,一直存在争论。本系统综述和荟萃分析旨在阐明与这两种手术相关的生存结局和术后并发症的潜在差异。
■在多个数据库中进行了详尽的文献检索,即PubMed,Embase,科克伦图书馆,和WebofScience。我们通过RevMan5.4软件使用随机效应模型对与SP和脾脏保存相关的风险比(HR)和风险比(RR)进行荟萃分析。亚组分析基于纳入研究的各种属性。我们采用漏斗图来评估发表偏倚,并进行了敏感性分析,以衡量综合结果的稳定性。漏斗图和灵敏度分析均使用Stata12进行。
■我们的研究纳入了23项观察性研究和三项随机对照试验,共涉及6,255名患者。与脾保存相比,SP没有产生更好的生存结果,该结论与随机对照试验的综合结果一致.SP和脾保存之间的生存预后无统计学差异,无论患者是否患有近端胃癌或近端胃癌侵入胃的更大曲率。SP显示所有术后并发症的发生率较高,尤其是胰瘘和腹腔脓肿。然而,在吻合口漏方面,它与脾保存没有显着差异,切口感染,肠梗阻,腹腔出血,和肺部感染。SP和脾保存之间的术后死亡率没有显着差异。漏斗图表明没有明显的出版偏见,敏感性分析证实了综合结果的稳定性。
■尽管在某些个体并发症和术后死亡率方面没有显著差异,我们的数据更广泛的模式表明,SP与术后并发症的总体频率更高相关,与脾保存相比,没有提供额外的生存益处。因此,不提倡SP的常规实施。
当医生为胃(胃)癌进行手术时,他们有时会切除脾脏,称为脾切除术(SP)的程序。然而,关于切除脾脏是否比保存脾脏更好,存在争议。我们的研究旨在比较这两种方法的患者生存率和手术后并发症的风险。要做到这一点,我们研究了26项研究的数据,涉及6,255例患者.我们的分析很彻底,使用先进的统计方法来确保准确性。我们发现:切除脾脏的患者的寿命并不比保留脾脏的患者更长。无论癌症是在胃的上部还是已经扩散到附近的胃的大曲线,两组的生存率相似.接受SP的患者面临更多的术后并发症,尤其是胰瘘和腹内脓肿.然而,一些并发症,如手术关节渗漏,伤口感染,肠梗阻,内出血,和肺部感染,两组间差异无统计学意义。无论患者是否切除脾脏,术后死亡的机会都相似。我们的发现表明,在胃癌手术期间常规切除脾脏并不能提高生存率,并且与更多的术后并发症有关。因此,除非绝对必要,否则最好避免切除脾脏。
UNASSIGNED: There is an ongoing debate regarding the comparative merits of splenectomy (SP) and splenic preservation in the surgical management of gastric cancer. This systematic review and meta-analysis aims to shed light on potential differences in survival outcomes and postoperative complications associated with these two procedures.
UNASSIGNED: An exhaustive literature search was conducted across multiple databases, namely PubMed, Embase, Cochrane Library, and Web of Science. We utilized a random-effects model via RevMan 5.4 software to conduct a meta-analysis of the hazard ratios (HRs) and risk ratios (RRs) associated with SP and spleen preservation. Subgroup analyses were based on various attributes of the included studies. We employed funnel plots to assess publication bias, and sensitivity analysis was conducted to gauge the stability of the combined results. Both funnel plots and sensitivity analysis were performed using Stata 12.
UNASSIGNED: Our research incorporated 23 observational studies and three randomized controlled trials, involving a total of 6,255 patients. SP did not yield superior survival outcomes in comparison to splenic preservation, a conclusion that aligns with the combined results of the randomized controlled trials. No statistically significant difference in survival prognosis was observed between SP and splenic preservation, irrespective of whether the patients had proximal gastric cancer or proximal gastric cancer invading the stomach\'s greater curvature. SP exhibited a higher incidence of all postoperative complications, notably pancreatic fistula and intraabdominal abscesses. However, it did not significantly differ from splenic preservation in terms of anastomotic leakage, incision infection, intestinal obstruction, intra-abdominal bleeding, and pulmonary infection. No significant difference in postoperative mortality between SP and splenic preservation was found. Funnel plots suggested no notable publication bias, and sensitivity analysis affirmed the stability of the combined outcomes.
UNASSIGNED: Despite the lack of significant differences in certain individual complications and postoperative mortality, the broader pattern of our data suggests that SP is associated with a greater overall frequency of postoperative complications, without providing additional survival benefits compared to splenic preservation. Thus, the routine implementation of SP is not advocated.
When doctors perform surgery for gastric (stomach) cancer, they sometimes remove the spleen, a procedure known as splenectomy (SP). However, there’s a debate on whether removing the spleen is better than preserving it. Our study aimed to compare these two methods in terms of patient survival and the risk of complications after surgery. To do this, we looked at data from 26 studies involving 6,255 patients. Our analysis was thorough, using advanced statistical methods to ensure accuracy. Here’s what we found: patients who had their spleen removed did not live longer than those who kept their spleen. Whether the cancer was just in the upper part of the stomach or had spread to the nearby large curve of the stomach, the survival rates were similar for both groups. Patients who underwent SP faced more postoperative complications, especially issues like pancreatic fistula and intra-abdominal abscesses. However, for some complications like leakage from the surgical joint, infection of the wound, bowel obstruction, internal bleeding, and lung infections, there was no significant difference between the two groups. The chances of dying post-surgery were similar whether patients had their spleen removed or not. Our findings suggest that routinely removing the spleen during gastric cancer surgery does not improve survival rates and is linked to more postoperative complications. Therefore, it may be better to avoid removing the spleen unless absolutely necessary.