Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Gastric Cancer: A Meta-analysis
Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Gastric Cancer: A Meta-analysis
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腹腔镜胃切除术与 D2 淋巴结清扫术治疗胃癌的开腹手术：荟萃分析
DOI：
10.1097/sle.0b013e31822d02dc
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发表时间：
2011-12
期刊：
影响因子：
--
通讯作者：
Fang, Jia-Feng
中科院分区：
文献类型：
--
作者：
Wei, Hong-Bo;Wei, Bo;Qi, Cui-Ling;Chen, Tu-Feng;Huang, Yong;Zheng, Zong-Heng;Huang, Jiang-Long;Fang, Jia-Feng
背景资料：腹腔镜胃切除术联合D2淋巴结清扫术（LGD 2）是目前治疗胃癌的一种新方法，可替代开腹胃癌根治术（OGD 2）。但它还没有得到广泛的接受，其肿瘤安全性仍然存在争议。本研究旨在通过荟萃分析评价LGD 2的有效性和安全性。材料与方法：在MEDLINE、Current Contents和Pubmed中检索2001年1月至2010年4月以英文发表的比较LGD 2和OGD 2治疗胃癌的临床试验的原始文章。由2名评价者独立进行严格的文献评价和数据提取，然后使用RevMan 4.2.5进行荟萃分析，以评价手术时间、失血量、收获的淋巴结、镇痛药物、首次排气日、术后住院时间、术后并发症和累积生存率。结果：纳入10项试验，共1039例患者（LGD 2组495例，OGD 2组544例）。与OGD 2相比，LGD 2显示出术中失血量少[加权平均差（WMD），-114.98; 95%置信区间（CI），-160.44至69.52; P <0.00001]，术后疼痛少（WMD，− 0.89; 95% CI，− 1.54至− 0.32; P = 0.002），排气较早（WMD，− 0.84; 95% CI，− 1.25至− 0.43; P <0.0001），住院时间缩短（WMD，-3.27; 95%CI，-4.54 to-2.00; P <0.00001），术后并发症较少[比值比（OR），0.56; 95%CI，0.32 - 0.59; P = 0.03];但手术时间较长[WMD，57.14; 95% CI，38.12-76.15; P <0.00001]。LGD 2和OGD 2之间在收获的淋巴结（WMD，-2.07; 95%CI，-4.27至-0.14; P = 0.07）和11至60个月随访的总生存率（OR，1.44; 95%CI，0.92 - 2.27; P = 0.11）方面没有显著差异。结论：这项荟萃分析的结果表明，与OGD 2相比，LGD 2导致失血量和术后并发症更少，疼痛更少，肠功能恢复更快，收获的淋巴结和总生存率相似。然而，我们也看到需要进一步的高质量随机对照试验来比较这两种方法。
Background: Nowadays laparoscopic gastrectomy with D2 lymph node dissection (LGD2) is used for gastric cancer, which provides an alternative to open radical gastrectomy (OGD2). But it has not gained wide acceptance, and its oncological safety remains controversial. The aim of this study is to evaluate the efficiency and safety of LGD2 through a meta-analysis. Materials and Methods: Original articles of clinical trials comparing LGD2 and OGD2 for gastric cancer, published in English language from January 2001 to April 2010 were searched in the MEDLINE, Current Contents, and Pubmed. Strict literature appraisal and data extraction were carried out independently by 2 reviewers and then a meta-analysis was performed using RevMan 4.2.5 to evaluate the items of operative time, blood loss, harvested lymph nodes, analgesic medication, first flatus day, postoperative hospital stay, postoperative complications, and cumulative survival rate. Results: Ten trials were involved in the meta-analysis, concerning a total of 1039 patients (495 in LGD2 and 544 in OGD2). Compared with OGD2, LGD2 showed advantages of less blood loss during operation [weighed mean difference (WMD), −114.98; 95% confidence interval (CI), −160.44 to −69.52; P<0.00001], less postoperative pain (WMD, −0.89; 95% CI, −1.54 to −0.32; P=0.002), earlier passage of flatus (WMD, −0.84; 95% CI, −1.25 to −0.43; P<0.0001), shorter hospital stay (WMD, −3.27; 95% CI, −4.54 to −2.00; P<0.00001), and less postoperative complications [odds ratio (OR), 0.56; 95% CI, 0.32-0.59; P=0.03]; but with longer operative time [WMD, 57.14; 95% CI, 38.12-76.15; P<0.00001]. There were no significant differences between LGD2 and OGD2 in harvested lymph nodes (WMD, −2.07; 95% CI, −4.27 to -0.14; P=0.07) and overall survival rate of 11 to 60 months’ follow-up (OR, 1.44; 95% CI, 0.92-2.27; P=0.11). Conclusions: The results of this meta-analysis suggest that LGD2 results in less blood loss and postoperative complications and also less pain and faster bowel function recovery, with similar harvested lymph nodes and overall survival rate comparing to OGD2. However, we also see the need for further high-quality randomized controlled trials comparing the 2 procedures.
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影响因子：
2.6
作者：
Kawamura, Hideki;Yokota, Ryoichi;Kondo, Yukifumi
通讯作者：
Kondo, Yukifumi
DOI：
10.1007/s10120-006-0380-9
发表时间：
2006-01-01
期刊：
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
影响因子：
--
作者：
Shiraishi, Norio;Yasuda, Kazuhiro;Kitano, Seigo
通讯作者：
Kitano, Seigo
DOI：
10.1007/s00464-005-0409-x
发表时间：
2007-01-01
影响因子：
3.1
作者：
Pugliese, R.;Maggioni, D.;de Martini, P.
通讯作者：
de Martini, P.
影响因子：
9
作者：
Kitano, Seigo;Shiraishi, Norio;Tanigawa, Nobuhiko
通讯作者：
Tanigawa, Nobuhiko
DOI：
10.1007/s00464-008-0198-0
发表时间：
2009-08-01
影响因子：
3.1
作者：
Lee, Joo-Ho;Yom, Cha-Kyong;Han, Ho-Seong
通讯作者：
Han, Ho-Seong