中国普外基础与临床杂志

中国普外基础与临床杂志

对比分析全腹腔镜与腹腔镜辅助全胃切除术近期疗效的 meta 分析

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目的 对比分析全腹腔镜全胃切除术(TLTG)与腹腔镜辅助全胃切除术(LATG)两种术式在治疗可切除胃癌方面的近期疗效。 方法 计算机检索 EMbase、PubMed、The Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网及万方数据库,按文献的纳入与排除标准筛选出符合要求的对比研究文献,提取相关数据并进行文献评估,应用 Revman 5.3 软件进行 meta 分析。 结果 共纳入 11 篇文献(6 篇中文文献,5 篇英文文献),包括 1 491 例临床诊断明确的胃癌患者。meta 分析结果显示,与 LATG 组相比,TLTG 组在治疗胃癌方面术中出血量少 [MD=–17.59,95%CI(–30.81,–4.37),P=0.009]、切口长度短 [MD=–4.50,95%CI(–4.92,–4.09),P<0.000 01]、术后首次肛门排气时间早 [MD=–0.16,95%CI(–0.28,–0.04),P=0.007]、术后首次进流食时间早 [MD=–0.47,95%CI(–0.86,–0.08),P=0.02]、术后住院时间短 [MD=–0.59,95%CI(–0.94,–0.24),P=0.000 9]、术后第 1 天和第 3 天疼痛视觉模拟评分均低 [术后第 1 天:MD=–3.10,95%CI(–3.48,–2.72),P<0.000 01;术后第 3 天MD=–2.30,95%CI(–2.57,–2.03),P<0.000 01],而 2 组在手术时间、近端切缘距离、远端切缘距离、淋巴结清扫数目及术后不良反应方面差异均无统计学意义(P>0.05)。并发症亚组分析结果显示,TLTG 组与 LATG 组在吻合口漏、吻合口出血及吻合口狭窄方面比较差异均无统计学意义(P>0.05)。 结论 TLTG 在治疗可切除胃癌方面具有出血少、切口短、通气及进食时间早、术后住院时间短及术后疼痛轻的优点,但因纳入研究的数量和质量限制,以上结论仍需开展更多高质量的研究予以验证。

Objective To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer. Methods The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis. Results A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss [MD=–17.59, 95% CI (–30.81, –4.37), P=0.009], shorter incision length [MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01], and earlier first anal exhaust time [MD=–0.16, 95% CI (–0.28, –0.04), P=0.007]in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier [MD=–0.47, 95% CI (–0.86, –0.08), P=0.02] and the postoperative hospital stay of the TLTG group was shorter [MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9]; In the TLTG group, the VAS score was lower on the first postoperative day [MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01] and on the third postoperative day [MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01]. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05). Conclusions TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.

关键词: 胃癌; 腹腔镜全胃切除术; meta 分析

Key words: gastric cancer; laparoscopic total gastrectomy; meta-analysis

引用本文: 杜恒锐, 王振江, 任彦先, 展昊, 张耕源, 焦作义. 对比分析全腹腔镜与腹腔镜辅助全胃切除术近期疗效的 meta 分析. 中国普外基础与临床杂志, 2018, 25(11): 1343-1352. doi: 10.7507/1007-9424.201807074 复制

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1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
2. Li Z, Wang Y, Shan F, et al. ypTNM staging after neoadjuvant chemotherapy in the Chinese gastric cancer population: an evaluation on the prognostic value of the AJCC eighth edition cancer staging system. Gastric Cancer, 2018 May 10. doi: 10.1007/s10120-018-0830-1.
3. Giampieri R, Del Prete M, Cantini L, et al. Optimal management of resected gastric cancer. Cancer Manag Res, 2018, 10: 1605-1618.
4. Seki Y, Kasama K, Haruta H, et al. Five-year-results of laparoscopic sleeve gastrectomy with duodenojejunal bypass for weight loss and type 2 diabetes mellitus. Obes Surg, 2017, 27(3): 795-801.
5. 梁世妙, 吴丽玲, 许乙威, 等. 全腔镜与腔镜辅助胃癌根治全胃切除术的临床疗效比较. 现代诊断与治疗, 2016, 27(22): 4199-4201.
6. 肖飞, 胡波, 宋亚峰, 等. 全腔镜与腔镜辅助胃癌根治全胃切除术的临床疗效比较. 武汉大学学报(医学版), 2015, 36(5): 786-788.
7. 崔成龙, 梁伟, 朱志强, 等. 完全腹腔镜下全胃切除术治疗胃上部癌的安全可行性及近期疗效. 中国普通外科杂志, 2015, 24(10): 1377-1382.
8. 张媛媛, 马玉红, 张福新. 全腔镜与腔镜辅助胃癌根治性切除术的临床疗效及安全性比较. 中国医药指南, 2017, 15(10): 147-148.
9. 潘宇, 牟一平. 完全腹腔镜全胃切除术近期疗效临床研究. 浙江大学, 2015.
10. 华龙, 王晨宇. 全腹腔镜与腹腔镜辅助全胃切除术对胃上部癌患者的治疗效果对比. 癌症进展, 2017, 15(2): 186-188, 192.
11. Chen K, Pan Y, Zhai ST, et al. Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods. BMC Gastroenterol, 2017, 17(1): 78.
12. Ito H, Inoue H, Odaka N, et al. Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study. Surg Endosc, 2014, 28(6): 1929-1935.
13. Kim HS, Kim MG, Kim BS, et al. Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy methods for the surgical treatment of early gastric cancer near the gastroesophageal junction. J Laparoendosc Adv Surg Tech A, 2013, 23(3): 204-210.
14. Kim HB, Kim SM, Ha MH, et al. Comparison of reduced port totally laparoscopic-assisted total gastrectomy (duet TLTG) and conventional laparoscopic-assisted total gastrectomy. Surg Laparosc Endosc Percutan Tech, 2016, 26(6): e132-e136.
15. Kim EY, Choi HJ, Cho JB, et al. Totally laparoscopic total gastrectomy versus laparoscopically assisted total gastrectomy for gastric cancer. Anticancer Res, 2016, 36(4): 1999-2003.
16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin, 2015, 65(1): 5-29.
18. Cao LL, Lu J, Lin JX, et al. Incidence and survival trends for gastric neuroendocrine neoplasms: An analysis of 3523 patients in the SEER database. Eur J Surg Oncol, 2018, 44(10): 1628-1633.
19. 王林俊, 徐皓, 徐泽宽. 全腹腔镜胃癌根治术消化道重建方法选择与评价. 中华胃肠外科杂志, 2017, 20(10): 1113-1116.
20. Roberto M, Botticelli A, Strigari L, et al. Prognosis of elderly gastric cancer patients after surgery: a nomogram to predict survival. Med Oncol, 2018, 35(7): 111.
21. Wang W, Liu Z, Xiong W, et al. Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method. Surg Endosc, 2016, 30(5): 2030-2035.
22. Kukar M, Gabriel E, Ben-David K, et al. Laparoscopic proximal gastrectomy for gastric neoplasms. J Surg Oncol, 2018, 118(1): 95-100.
23. Nakauchi M, Suda K, Kadoya S, et al. Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc, 2016, 30(10): 4632-4639.
24. Tsunoda S, Okabe H, Tanaka E, et al. Laparoscopic gastrectomy for remnant gastric cancer: a comprehensive review and case series. Gastric Cancer, 2016, 19(1): 287-292.
25. Nagai E, Nakata K, Ohuchida K, et al. Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study. Surg Endosc, 2014, 28(1): 289-296.
26. Shinohara T, Hanyu N, Tanaka Y, et al. Totally laparoscopic complete resection of the remnant stomach for gastric cancer. Langenbecks Arch Surg, 2013, 398(2): 341-345.
27. Son SY, Lee CM, Jung DH, et al. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience. Gastric Cancer, 2015, 18(1): 177-182.
28. So KO, Park JM. Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer, 2011, 11(4): 206-211.
29. Umemura A, Koeda K, Sasaki A, et al. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg, 2015, 38(2): 102-112.
30. 蔡逊, 叶家欣, 马丹丹, 等. 完全腹腔镜与腹腔镜辅助胃癌根治术近期临床疗效的对比研究. 中国普外基础与临床杂志, 2016, 23(2): 186-191.
31. 丁蔚, 谭玉林, 薛文波, 等. 全腹腔镜全胃切除手术与腹腔镜辅助全胃切除手术比较治疗胃癌疗效和安全性的 Meta 分析. 中国循证医学杂志, 2018, 18(1): 21-28.
32. Chen K, Pan Y, Cai JQ, et al. Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol, 2016, 14: 96.