학술논문
Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies
Document Type
Academic Journal
Author
Source
Cancers. December 2023, Vol. 16 Issue 1
Subject
Language
English
ISSN
2072-6694
Abstract
Author(s): Stefano Granieri (corresponding author) [1,*]; Annaclara Sileo [2]; Michele Altomare [3]; Simone Frassini [4]; Elson Gjoni [1]; Alessandro Germini [1]; Alessandro Bonomi [2]; Eigo Akimoto [5]; Chun Lam Wong [...]
Local recurrence is a significant issue for advanced gastric cancer patients. Complete mesogastric excision (CME) has been advocated to enhance lymph node (LN) retrieval and reduce recurrence rates. A systematic review of the literature was conducted according to the Cochrane recommendations, and meta-analyses of means and binary outcomes were developed. The number of lymph nodes retrieved was the primary endpoint, with other postoperative outcomes as secondary. Thirteen studies were included, showing that the mean number of harvested LNs was significantly higher among patients undergoing CME. CME patients also had significantly lower intraoperative blood loss, a shorter length of stay, and a shorter operative time. Radical gastrectomy with CME may provide a safe and more radical lymphadenectomy. Long-term outcomes and the applicability of this technique in the West are still to be proven. Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25–4.86; 95%; p = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.
Local recurrence is a significant issue for advanced gastric cancer patients. Complete mesogastric excision (CME) has been advocated to enhance lymph node (LN) retrieval and reduce recurrence rates. A systematic review of the literature was conducted according to the Cochrane recommendations, and meta-analyses of means and binary outcomes were developed. The number of lymph nodes retrieved was the primary endpoint, with other postoperative outcomes as secondary. Thirteen studies were included, showing that the mean number of harvested LNs was significantly higher among patients undergoing CME. CME patients also had significantly lower intraoperative blood loss, a shorter length of stay, and a shorter operative time. Radical gastrectomy with CME may provide a safe and more radical lymphadenectomy. Long-term outcomes and the applicability of this technique in the West are still to be proven. Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25–4.86; 95%; p = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.