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Laparoscopic Versus Open Gastrectomy for Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials.
Bittar, Vinicius; Boneli, Mauricio Ferreira; Reis, Pedro C Abrahão; Felix, Nicole; Braga, Marcelo Antonio Pinheiro; Rocha, Kian M; Fogaroli, Leonardo O; Costa, Gamaliel B; Comini, Ana Carolina; Amaral, Gustavo; Marini, Danyelle Cristine; Camandaroba, Marcos P G.
Afiliação
  • Bittar V; Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil. vinibdepontes@gmail.com.
  • Boneli MF; Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil.
  • Reis PCA; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
  • Felix N; Universidade Federal de Campina Grande, Campina Grande, Brazil.
  • Braga MAP; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
  • Rocha KM; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
  • Fogaroli LO; Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil.
  • Costa GB; Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil.
  • Comini AC; A. C. Camargo Cancer Center, São Paulo, Brazil.
  • Amaral G; Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil.
  • Marini DC; Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil.
  • Camandaroba MPG; A. C. Camargo Cancer Center, São Paulo, Brazil.
J Gastrointest Cancer ; 55(2): 652-661, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38564116
ABSTRACT

BACKGROUND:

Laparoscopy-assisted gastrectomy (LAG) is a well-established surgical technique in treating patients with early gastric cancer. However, the efficacy and safety of LAG versus open gastrectomy (OG) in patients with advanced gastric cancer (AGC) remains unclear.

METHODS:

We systematically searched PubMed, Embase, and Cochrane Library in June 2023 for RCTs comparing LAG versus OG in patients with AGC. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous endpoints, respectively. We performed all statistical analyses using R software version 4.3.1 and a random-effects model.

RESULTS:

Nine RCTs comprising 3827 patients were included. There were no differences in terms of intraoperative complications (RR 1.14; 95% CI 0.72 to 1.82), number of retrieved lymph nodes (MD -0.54 lymph nodes; 95% CI -1.18 to 0.09), or mortality (RR 0.91; 95% CI 0.30 to 2.83). LAG was associated with a longer operative time (MD 49.28 minutes; 95% CI 30.88 to 67.69), lower intraoperative blood loss (MD -51.24 milliliters; 95% CI -81.41 to -21.06), shorter length of stay (MD -0.83 days; 95% CI -1.60 to -0.06), and higher incidence of pancreatic fistula (RR 2.44; 95% CI 1.08 to 5.50). Postoperatively, LAG was also superior to OG in reducing bleeding rates (RR 0.44; 95% CI 0.22 to 0.86) and time to first flatus (MD -0.27 days; 95% CI -0.47 to -0.07), with comparable results in anastomotic leakage, wound healing issues, major complications, time to ambulation, or time to first liquid intake. In the long-term analyses at 3 and 5 years, there were no significant differences between LAG and OG in terms of overall survival (RR 0.99; 95% CI 0.96 to 1.03) or relapse-free survival (RR 0.99; 95% CI 0.94 to 1.04).

CONCLUSION:

This meta-analysis of RCTs suggests that LAG may be an effective and safe alternative to OG for treating AGC; albeit, it may be associated with an increased risk for pancreatic fistula.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Ensaios Clínicos Controlados Aleatórios como Assunto / Laparoscopia / Gastrectomia Limite: Humans Idioma: En Revista: J Gastrointest Cancer Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Ensaios Clínicos Controlados Aleatórios como Assunto / Laparoscopia / Gastrectomia Limite: Humans Idioma: En Revista: J Gastrointest Cancer Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos