Evidence Based Medicine On The Hot Spots Of Gastric Cancer

Objective: To assess the advantages and effectiveness of the ESD and surgical treatment for the treatment of early gastric cancer through evidence-based medicine.Methods: using RevMan 5.3 software Meta to analysis literature published about the ESD and surgical treatment for the treatment of early gastric cancer from 2003-2015 through the development of appropriate search strategy.Results: One randomized controlled study and seven nonrandomized retrospective cohort studies(total 1881 participants,five fulltext and two abstracts)were included.Meta-analysis showed that there was no statistically significant differences in 5-year overall survival rate(568/606,93.7% vs590/619,95.3%,P=0.53)、local recurrence rate(4/366,1.1%vs0/575,0.00%,P=0.09)and operation-related death(0/437,5.0%vs 5/441,1.1%,P=0.16)between ESD and surgery.However,it had significant higher procedure-related complication(52/698,7.4% vs100/688,14.5%,P〈0.00001).Conclusion: ESD and surgical operation have basically equivalent efficacy for the treatment of early gastric cancer.However,ESD should be the first choice.Objective: To compare the efficacy of proximal gastrectomy(PG)and total gastrectomy(TG)for the Gastric cardia cancer.Methods: using RevMan 5.3 software Meta to analysis literature published about radical proximal gastrectomy and radical total gastrectomy treatment of gastric cardia from 2003-2015 through the development of appropriate search strategy.Results: One randomized controlled study and seven nonrandomized retrospective cohort studies(total 1783 participants)were included.Meta-analysis showed that there was no statistically significant differences in 5-year overall survival rate(47/941,5.0%vs66/475,13.9%,P=0.56)between proximal gastrectomy and total gastrectomy.But total gastrectomy had lower procedure-related complication(92/589,15.6% vs115/321,35.7%,P 〈 0.00001)、 Reflux esophagitis(13/5802.2% vs42/239,17.6%,P〈0.00001)、anastomotic stenosis(607/823,73.8% vs369/497,74.2%,P〈0.00001)than proximal gastrectomy.Conclusion: TG is superir to PG in reducing the morbidity of anastomotic stensis and reflux esophagitis.Objective: To compare the efficacy of D2 lymph node dissection and D3 lymph node dissection for the advanced gastric cancer.Methods: using Rev Man 5.3 software Meta to analysis literature published about D2 lymph node dissection and D3 lymph node dissection for the advanced gastric cancer from2003-2015 through the development of appropriate search strategy.Results: One randomized controlled study and seven nonrandomized retrospective cohort studies(total 1948 participants)were included.Meta-analysis showed that there was no statistically significant differences in 5-year overall survival rate(257/453,56.8%vs283/471,60.0%,P=0.25)between D2 lymph node dissection and D3 lymph node dissection in the patients with advanced gastric cancer.But D2 lymph node dissection had lower procedure-related complication(95/580,16.4% vs132/579,22.8%,P=0.004)、mortality(13/5802.2% vs42/239,17.6%,P〈0.00001)、anastomotic stenosis(5/680,0.7% vs16/613,2.6%,P=0.008)than D3 lymph node dissection,and the operation time(MD,-78.72,P〈0.000001)is shorter.Conclusion: D2 lymph node dissection is superir to D3 lymph node dissection in reducing the mortality and anastomotic stenosis.