Endoscopic resection versus radical gastrectomy for early gastric cancer in Asia: A meta-analysis

INTERNATIONAL JOURNAL OF SURGERY

卷:48

Review

Ning, Fei-Long^1,2,3  Zhang, Chun-Dong¹  Wang, Peng¹  Shao, Shuai¹  Dai, Dong-Qiu^1,4,5 

[1] China Med Univ, Dept Gastrointestinal Surg, Affiliated Hosp 4, Shenyang, Liaoning, Peoples R China

[2] Xuzhou Hosp Tradit Chinese Med, Dept Gen Surg, Xuzhou, Jiangsu, Peoples R China

[3] Nanjing Univ Chinese Med, Affiliated Xuzhou Hosp, Dept Gen Surg, Xuzhou, Jiangsu, Peoples R China

[4] China Med Univ, Canc Res Inst, Shenyang, Liaoning, Peoples R China

[5] China Med Univ, Affiliated Hosp 4, Canc Ctr, Shenyang, Liaoning, Peoples R China

关键词: Early gastric cancer;    Asia;    Endoscopic resection;    Radical gastrectomy;    Meta-analysis;   

DOI  :  10.1016/j.ijsu.2017.09.068

来源: Elsevier

【 摘 要 】

Background: To compare the efficacy and safety of endoscopic resection (ER) and radical gastrectomy (RG) for early gastric cancer (EGC) in Asia. Materials and methods: We systematically searched relevant articles published before September 1, 2017. We evaluated the quality of the included non-randomized studies using the Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using RevMan 5.3 software. The odds ratio (OR) with 95% confidence intervals (CI) were used for the dichotomous data. Results: Fifteen retrospective studies were included in this analysis (3737 patients in the ER group and 4246 patients in RG group). No significant differences in the three-year survival rate (OR, 0.87; 95% CI, 0.50-1.53) and five-year survival rate (OR, 0.81; 95% CI, 0.58-1.13) between the ER and RG groups were observed. Although patients undergoing ER had a higher risk of recurrence (OR, 6.07; 95% CI 4.17-8.84) and the occurrence of metachronous cancer (OR, 8.35; 95% CI, 5.48-12.75), recurrent or metachronous gastric cancers following ER were successfully detected and removed using the endoscopic technique. Higher recurrence in the ER group may be associated with its lower en bloc resection rate (OR, 0.05; 95% CI, 0.02-0.14) and complete resection rate (OR, 0.03; 95% CI, 0.01-0.08). Importantly, although the three-year survival and five-year survival were similar in the two groups, the complication rate in the ER group was significantly lower than that in the RG group. Conclusion: ER is a good choice for patients with small EGC lesions (<= 2 cm) without lymph node metastasis, especially in elderly patients with various medical comorbidities and in patients who cannot tolerate abdominal surgery or who meet the criteria but decline surgery. In contrast, RG is recommended when the diameter of the tumor is large (> 2 cm) and preoperative examination suggests the possible presence of lymph node metastasis.

【 授权许可】

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