Systematic review of laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer / 肿瘤

ABSTRACT

Objective: To evaluate the safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) in treating early gastric cancer. Methods: We searched randomized controlled trials (RCTs) published in MEDLINE, EMBASE, the Chinese Biomedical Database (CBM) and Cochrane Central Register from 1991 to March 2007 and included RCTs compared LADG to ODG for early gastric cancer. We also evaluated the methodological quality of included studies that involved randomization, blinding, contral. Meta-analysis was performed using Revman 4.2.9 software. Results: Four RCT involving 123 patients were included. Compared to open distal gastrectomy(ODG), LADG had less complications[odd ratio(OR)0.33, 95% confidence interval(CI) (0.14 to 0.77)], less estimated blood loss [weight mean difference(WMD) -85.72, 95% CI (-166.87 to -4.58)], lower frequency of analgesic requirement [WMD - 1.69, 95% CI(-2.18 to -1.21)], more early postoperative first flatus [WMD -0.68, 95% CI (-1.26 to -0.09)]. There was no significant difference between two groups in duration of hospital stay, wound or anastomotic complications, recurrence rate, metastasis rate, death rate and survival rate. The mean number of harvested lymph nodes was less or equal to ODG. But the operation time was significantly longer in LADG. Conclusion: In this systematic review, the short-term outcome of LADG for early gastric cancer is superior to ODG, and the long-term outcome is similar with ODG.