Meta-analysis Of Laparoscopic Pylorus-preserving Gastrectomy For Early Gastric Cancer

Objective:In this study,we compared the postoperative clinical indexes of two different surgical methods of laparoscopic pylorus-preserving gastrectomy(LPPG)and laparoscopic distal gastrectomy(LDG),and compared the two postoperative complications,and the safety and feasibility of pylorus-preserving gastrectomy under abdominal cavity.Make a comprehensive evaluation to choose a reasonable operation method for early gastric cancer located in the middle third of the stomach in the future.Methods:Through the search in Pub Med,Embase,Cochrane Library,Web of Science,China knowledge Network and Wan fang database,the retrieval time is to build the database until January 2021.The literatures about the comparison between laparosco-pic pylorus-preserving gastrectomy(LPPG)and laparoscopic distal gastrectomy(LDG)were screened.Review Manager5.3 software was used for Meta analysis,P<0.05.There was statistical significance.The classification variable uses the ratio ratio(OR)or the risk ratio(RR)and its 95%CI,and the continuity variable uses the mean difference(MD)or the weighted mean difference(WMD)and its 95%CI.The heterogeneity test between the research results is evaluated and determined by the I~2value.The clinical parameters and postoperative quality of life of patients undergoing laparoscopic pylorus preserving gastrectomy(LPPG)and laparoscopic distal gastrectomy(LDG)were compared,including operation time,operative blood loss,length of hospital stay,delayed gastric emptying,cholecystolithiasis and overall complications.Results:A total of 9 articles were included in this study,including 8 retrospective cohort studies(RCS)and 1 randomized controlled study(RCT),including 6 English articles and 3 Chinese articles.Laparoscopic pylorus-preserving gastrectomy(LPPG)group and laparoscopic distal gastrectomy(LDG)group.The results were as follows:1.Operation time:there was no significant difference between LPPG group and LDG group.WMD=5.45;95%confidence interval was[-9.15 20.04].2.Intraoperative bleeding:there was no significant difference between LPPG group and LDG group,and the WMD=-11.64;95%confidence interval was[-56.91,0.61].3.The length of hospital stay:there was no significant difference between LPPG group and LDG group,and the WMD=0.19;95%confidence interval was[-0.75 1.12],0.69respectively.4.Delayed gastric emptying:the confidence interval of OR=4.32;95%was[2.06～9.05],and the difference was statistically significant(0.0001<0.05).The results showed that delayed gastric emptying was more likely to occur in LPPG group than in LGD group.5.Cholecystolithiasis:the confidence interval of OR=0.34;95%was[0.13～0.86],and the difference was statistically significant(0.02<0.05).The results showed that the incidence of postoperative cholecystolithiasis in LDG group was higher than that in LPPG group.6.The overall complication:the confidence interval of OR=0.90;95%was[0.63～1.30],and the confidence interval was 0.58>0.05.The results showed that there was no significant difference in overall complications between LPPG group and LDG group.Conclusion:In early gastric cancer in the middle part of the stomach,the quality of life of patients after laparoscopic pylorus-preserving gastrectomy(LPPG)is improved,the incidence of gallstone is low,and the operation time,intraoperative blood loss,hospital stay and overall postoperative complications are similar to those of laparoscopic distal gastrectomy(LDG).Laparoscopic pylorus-preserving gastrectomy(LPPG)is a feasible and safe operation.