Laparoscopy-assisted Pylorus-preserving Gastrectomy Versus Laparoscopy-assisted Distal Gastrectomy For Early Gastric Cancer:A Meta-analysis

Background Pylorus-preserving gastrectomy can improve the quality of life of patients with gastric cancer,so it has been widely used in the treatment of early middle gastric cancer.Compared with laparoscopic-assisted distal gastrectomy,the safety of laparoscopy-assisted pylorus-preserving gastrectomy and whether it increases the incidence of postoperative complications are not clear.The aim of this meta-analysis was to evaluate the short-term efficacy of laparoscopy-assisted pylorus-preserving gastrectomy for early middle gastric cancer.Methods The retrieval databases included PubMed,Cochrane,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,and China Scientific and Technological Journal Database(VIP),etc.The retrieval literatures included control studies on laparoscopy-assisted pylorus-preserving gastrectomy versus laparoscopic-assisted distal gastrectomy in the treatment of early middle gastric cancer.The evaluation indexes included in the meta-analysis included: duration of surgery,intraoperative blood loss,number of lymph dissection,length of hospital stay after surgery,postoperative complications,anastomotic leakage,delayed gastric emptysis,postoperative intestinal obstruction,incision infection,pulmonary infection,abdominal infection,and postoperative gallstone incidence.RevMan 5.4statistical software was used for data integration analysis.Results A total of 14 literatures were screened to meet the standards of nanosectomy,including a total of 1985 patients,including 803 patients in the group of laparoscopy-assisted pylorus-preserving and 1182 patients in the group of laparoscopic-assisted distal gastrectomy.Meta-analysis showed that laparoscopy-assisted pylorus-preserving gastrectomy increased the incidence of delayed gastric emptycompared with laparoscopic-assisted distal gastrectomy(OR=3.31,95%CI(2.03,5.39),P<0.00001).Except for delayed gastric emptying,there were no significant statistical differences in total postoperative complications,anastomotic fistula,postoperative intestinal obstruction,incision infection,abdominal infection and pulmonary infection.This meta-analysis also suggested that the number of lymph nodes dissected in the laparoscopy-assisted pylorus-preserving gastrectomy group was less than that in the laparoscopic-assisted distal gastrectomy group,and the difference was statistically significant(WMD=-1.33,95%CI(-2.08,-0.57),P=0.0006).However,there were no significant differences between the two groups in operation time(WMD=6.73,95%CI(-8.53,21.99),P=0.39),intraoperative blood loss(WMD=-9.50,95%CI(-32.96,13.95),P=0.43),and postoperative hospital stay(WMD= 0.26,95%CI(-0.40,0.92),P=0.44).Conclusion Laparoscopy-assisted pylorus-preserving and laparoscopic-assisted distal gastrectomy in terms of surgical feasibility and safety for patients with early gastric cancer.However,Laparoscopy-assisted pylorus-preserving increases the risk of delayed gastric emptying.