Robotic versus laparoscopic gastrectomy for gastric cancer: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy with meta-analysis between robot-assisted gastrectomy(RAG) and laparoscopy-assisted gastrectomy (LAG) for gastric cancer.</p><p><b>METHODS</b>A literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, CNKI(Chinese National Knowledge Infrastructure), and CBM(China Biological Medicine) databases for clinical researches published before July 2015 that compared RAG with LAG. Operative time, estimated blood loss, harvested lymph nodes, proximal margin, distal margin, hospital stay, conversion and complications were compared using weighted mean differences(WMD) and odds ratios (OR).</p><p><b>RESULTS</b>Sixteen studies were included in the analysis, comprising 5 764 patients(1 593 RAGs, 4 171 LAGs). RAG was associated with longer operative time (WMD=49.68, 95% CI: 35.54 to 63.82, P=0.000), less estimated blood loss (WMD=-26.10, 95% CI: -42.90 to -9.31, P=0.002), and shorter hospital stay(WMD=-0.72, 95% CI: -1.35 to -0.09, P=0.024). Conversion, mortality, complications, proximal margin, distal margin and harvested lymph nodes of RAG were similar to LAG. In meta-analysis results of distal gastrectomy and early-stage gastric cancer, RAG had more harvested lymph nodes (distal gastrectomy: WMD=2.23, 95% CI: 0.33 to 4.13, P=0.021; early-stage gastric cancer: WMD=2.58, 95% CI: 1.05 to 4.12, P=0.001).</p><p><b>CONCLUSIONS</b>RAG can be performed safely with less estimated blood loss and more harvested lymph nodes as compared to LAG. Radical resection can be achieved by RAG.</p>

Association of prognosis with insulin-like growth factor receptor type I expression in gastric cancer patients: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To systemically evaluate the relationship between the expression of insulin-like growth factor receptor type I (IGF-1R) and prognosis in gastric cancer (GC) patients.</p><p><b>METHODS</b>A literature search was conducted from PubMed, EMBASE, Web of Science, CNKI, Wanfang and VIP databases to retrieve the clinical studies relevant to IGF-1R expression and its prognostic value in GC patients. Meta-analysis was performed using STATA 12.0 software. The methodology was assessed according to the European Lung Cancer Working Party Quality Scale for Biological Prognostic Factors for Lung Cancer. The quality of studies was assessed using the Newcastle-Ottawa scale.</p><p><b>RESULTS</b>Four eligible studies including 685 patients were enrolled for this meta-analysis. Analysis results suggested that up-regulation of IGF-1R in GC patients was significantly associated with TNM staging (OR=5.20, 95%CI:1.12 to 24.15, P=0.035), lymph node metastasis(OR=8.24, 95%CI:2.68 to 25.34, P=0.000) and distant metastasis(OR=17.34, 95%CI:6.52 to 46.15, P=0.000). Moreover, up-regulated IGF-1R expression was significantly associated with poor overall survival of gastric cancer patients(HR=2.63, 95% CI:1.29 to 5.40, Z=2.64, P=0.008).</p><p><b>CONCLUSION</b>High IGF-1R expression may be an adverse prognostic factor in gastric cancer patients.</p>

Multidisciplinary therapy for gastric cancer with liver metastasis / 中华胃肠外科杂志

Gastric cancer with liver metastasis (GCLM) is the leading cause of death in patients with advanced gastric cancer. Multiple metastasis was common in GCLM and usually complicated with lesions outside the liver, especially peritoneal metastasis. Most of liver metastasis lesions could not be resected radically. Currently, main treatments for GCLM included radical operation, palliative resection of gastric cancer, ablation of metastatic lesions, intervention and systemic chemotherapy. Based on the current progress in the treatment for GCLM and our clinical experience, the general status of patients, the type of gastric cancer and the degree of liver metastasis should be analyzed, and a cooperative multidisciplinary team (MDT) should be applied to conduct and to choose active and suitable comprehensive treatment for GCLM patients based on individualized therapy principle.

Comparison of clinical efficacy of different treatment methods for synchronous liver metastasis from gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of different treatments for synchronous liver metastasis from gastric cancer.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 271 patients with synchronous liver metastasis from gastric cancer between January 1998 and November 2012 were analyzed retrospectively. Among 271 patients, 34 received surgery alone, 95 received chemotherapy alone, and 120 received combined therapy. The prognosis was compared.</p><p><b>RESULTS</b>The median survival time was 8 months (3-41 months) in the surgery group and the cumulative 1-, 3- and 5-year survival rates were 32.4%, 2.9% and 0. The median survival time was 7 months (3-50 months) in the chemotherapy group and the cumulative 1-, 3- and 5-year survival rates were 21.1%, 1.1% and 0 respectively. The median survival time was 11 months (3-84 months) in the combined group and the cumulative 1-, 3- and 5-year survival rates were 50.0%, 5.0% and 0.8% respectively. The differences among groups were all statistically significant (all P<0.05). Extent of lymph node metastasis, therapeutic strategies, and liver metastasis management were significantly independent prognostic factors for synchronous liver metastasis from gastric cancer.</p><p><b>CONCLUSIONS</b>Comprehensive treatment based on operation may improve the long-term survival of patients with synchronous liver metastasis from gastric cancer.</p>

Meta-analysis of prognosis after surgical treatment in gastric cancer patients with liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the value of gastric and hepatic surgical treatment in gastric cancer patients with liver metastasis and its prognostic implication.</p><p><b>METHODS</b>Literature search was performed in pubmed, Embase, Ovid, Springer-Link, Web of Science, CNKI, CBMdisc for clinical research published before March 2013 that compared gastrectomy alone to gastrectomy and hepatectomy. Inclusion criteria and exclusion criteria were performed. Quality assessment was based on NOS scale. Stata12.0 was used for statistical analysis.</p><p><b>RESULTS</b>Nine studies including 431 patients were enrolled for analysis, among whom 189 underwent gastrectomy and hepatectomy and 242 underwent gastrectomy alone. Gastrectomy and hepatectomy group had better survival(HR=0.50, 95%CI:0.34-0.72, z=3.66, P=0.000). There was a subgroup analysis. Gastrectomy with hepatectomy group had significant advantages in prognosis in four foreign studies(HR=0.28, 95%CI:0.18-0.44, z=5.77, P=0.000). There was no significant difference in five domestic studies (HR=0.74, 95%CI:0.55-1.00, z=1.95, P=0.051).</p><p><b>CONCLUSION</b>Gastrectomy and hepatectomy in gastric cancer patients with liver metastasis improves long-term survival in select patients.</p>