RESUMEN
BACKGROUND: While laparoscopic gastrectomy is a prominent therapeutic approach for distal gastric cancer, the clinical benefits of 3D laparoscopy over 2D laparoscopy remain unclear. We aimed to compare the clinical outcomes of 3D laparoscopy and 2D laparoscopy for distal gastric cancer resection through a systematic review and meta-analysis. METHODS: We searched PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published from inception through January 2023, according to the PRISMA guidelines. The MD or RR was used to compare 3D and 2D distal gastrectomy. Random-effects meta-analysis was estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous outcomes. RESULTS: After reviewing 559 studies, 6 manuscripts met the inclusion criteria. The analysis included 689 patients, with 348 (50.5%) in the 3D group and 341 (49.5%) in the 2D group. 3D laparoscopic gastrectomy reduces the operative time (WMD - 28.57 min, 95% CI - 50.70 to - 6.44, p = 0.011), intraoperative blood loss (WMD - 6.69 mL, 95% CI - 8.09 to - 5.29, p < 0.001), and postoperative hospital stay (WMD - 0.92 days, 95% CI - 1.43 to - 0.42, p < 0.001). There were no significant differences in time to first postoperative flatus (WMD - 0.22 days, 95% CI - 0.50 to 0.05, p = 0.110), postoperative complications (Relative Risk 0.56, 95% CI 0.22 to 1.41, p = 0.217), and the number of retrieved lymph nodes (WMD 1.25, 95% CI - 0.54 to 3.03, p = 0.172) between 3 and 2D laparoscopic distal gastrectomy. CONCLUSION: Our study highlights the potential advantages of 3D laparoscopy in distal gastrectomy, including shorter operative time, postoperative hospital stay, and decreased intraoperative blood loss.
Asunto(s)
Laparoscopía , Neoplasias Gástricas , Humanos , Pérdida de Sangre Quirúrgica , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicaciones , Resultado del Tratamiento , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Gastrectomía/métodosRESUMEN
ABSTRACT Background: Re-fundoplication is the most often procedure performed after failed fundoplication, but re-failure is even higher. Aim: The objectives are: a) to discuss the results of fundoplication and re-fundoplication in these cases, and b) to analyze in which clinical situation there is a room for gastrectomy after failed fundoplication. Method: This experience includes 104 patients submitted to re-fundoplication after failure of the initial operation, 50 cases of long segment Barrett´s esophagus and 60 patients with morbid obesity, comparing the postoperative outcome in terms of clinical, endoscopic, manometric and 24h pH monitoring results. Results: In patients with failure after initial fundoplication, redo-fundoplication shows the worst clinical results (symptoms, endoscopic esophagitis, manometry and 24 h pH monitoring). In patients with long segment Barrett´s esophagus, better results were observed after fundoplication plus Roux-en-Y distal gastrectomy and in obese patients similar results regarding symptoms, endoscopic esophagitis and 24h pH monitoring were observed after both fundoplication plus distal gastrectomy or laparoscopic resectional gastric bypass, while regarding manometry, normal LES pressure was observed only after fundoplication plus distal gastrectomy. Conclusion: Distal gastrectomy is recommended for patients with failure after initial fundoplication, patients with long segment Barrett´s esophagus and obese patients with gastroesophageal reflux disease and Barrett´s esophagus. Despite its higher morbidity, this procedure represents an important addition to the surgical armamentarium.
RESUMO Racional: Re-fundoplicatura é o procedimento mais frequentemente realizado após falha na fundoplicatura, mas neste caso a falha é ainda maior. Objetivo: a) discutir os resultados da fundoplicatura e re-fundoplicatura nesses casos; e b) analisar em que situação clínica há espaço para gastrectomia após falha na fundoplicatura. Método: Esta experiência inclui 104 pacientes submetidos à re-fundoplicatura após falha da operação inicial, sendo 50 casos de esôfago de Barrett de segmento longo e 60 pacientes com obesidade mórbida, comparando-se o resultado pós-operatório em termos de pH clínico, endoscópico, manométrico de 24 h de monitoramento. Resultados: Em pacientes com falha após a fundoplicatura inicial, a re-fundoplicatura mostra os piores resultados clínicos (sintomas, esofagite endoscópica, manometria e pHmetria 24 h). Em pacientes com esôfago de Barrett de segmento longo, melhores resultados foram observados após fundoplicatura com gastrectomia distal em Y-de-Roux e em pacientes obesos resultados semelhantes em relação aos sintomas, esofagite endoscópica e monitoramento de pH 24 h foram observados após fundoplicatura com gastrectomia distal ou ressecção com bypass gástrico laparoscópico, enquanto que em relação à manometria, a pressão normal do EEI só foi observada após a fundoplicatura e gastrectomia distal. Conclusão: A gastrectomia distal é recomendada para pacientes com falha após a fundoplicatura inicial, pacientes com esôfago de Barrett de segmento longo e obesos com doença do refluxo gastroesofágico e esôfago de Barrett. Apesar de sua maior morbidade, esse procedimento representa um importante acréscimo ao arsenal cirúrgico.