Meta-analysis of the efficacy and safety of laparoscopic versus open surgery for elderly patients with advanced gastric cancer / 国际外科学杂志

ABSTRACT

Objective:To probe the security and effectiveness of laparoscopic mustard surgery in elderly patients with advanced gastric cancer and that of open label laparoscopic mustard surgery by Meta-analysis.Methods:From database creation to June 2022, PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang database, VIP database and Chinese Biomedical Literature (CBM) database were searched. RevMan5.3 software was used to make forest maps for Meta-analysis, and funnel plot was used to evaluate publication bias, and Egger was used to detect whether there was publication bias. The operation time, intraoperative blood loss, number of lymph nodes remove, time to first flatus, time to first oral diet, time to ambulation, length of hospital stay, and overall postoperative complications rate, incidence of postoperative wound infection, incidence of pulmonary infection, incidence of postoperative intestinal obstruction and incidence of anastomotic leakage were included and analyzed.Results:A total of 11 contributions were submitted, including 2 randomized controlled trials and 9 retrospective studies. The total number of patients included in this study was 1081, including 519 in the abdominal group and 562 in the open group. Results showed that the intraperitoneal group had less bleeding compared to open surgery ( MD=-104.21, 95% CI -132.54--75.89, P<0.00001), earlier first flatus ( MD=-1.90, 95% CI -2.19--1.49, P<0.00001), the first time to oral diet was earlier ( MD=-1.92, 95% CI -2.48--1.35, P<0.00001), the time of first landing after operation was earlier ( MD=-2.89, 95% CI -3.32--2.45, P<0.00001), the length of hospital stay was shorten ( MD=-6.08, 95% CI -7.20--4.97, P<0.00001), a lower overall postoperative complication rate ( OR=0.40, 95% CI 0.29-0.56, P<0.00001), the incidence of postoperative incision infection was lower ( OR= 0.33, 95% CI 0.17-0.67, P=0.002), the incidence of pulmonary infection was lower ( OR= 0.39, 95% CI 0.22-0.69, P=0.001), the operation time was longer ( MD=30.35, 95% CI 14.34-46.35, P=0.0002), and the differences were statistically significant ( P<0.05). There are no statistical significance in the number of lymph nodes remove( MD=-0.52, 95% CI -1.76-0.73, P=0.41), the incidence of postoperative intestinal obstruction ( OR= 0.38; 95% CI 0.13-1.13; P=0.08) and the incidence of anastomotic leakage ( OR= 0.41, 95% CI 0.16-1.06, P=0.07) between two groups. Conclusions:Compared with open radical gastrectomy, laparoscopic radical gastrectomy is safe and feasible for elderly patients with advanced gastric cancer as well, and even better than open radical gastrectomy in curative effect and radical treatment.