| Cardiac cancer refers to the lesions occurring from 1cm to 2cm above the boundary of the esophagus and gastric mucosa,mainly adenocarcinoma,has a high incidence and mortality,seriously threatening human health,and has been widely concerned by surgeons.Radical resection,including laparoscopic total gastrectomy(LTG)and laparoscopic proximal gastrectomy(LPG),remains the standard treatment for cardiac cancer due to the risk of lymph node metastasis.Often the decision of a gastrointestinal surgeon depends on the size of the tumor,the stage,and the volume of the remaining stomach.The advantage of LTG is that it allows for longer tumor-free margins and more thorough lymph node dissection.The advantages of LPG lie in the smaller scope of lymphatic dissection and the retention of the distal stomach,which means that LPG operates less on the lymph nodes and stomach,reducing surgical bleeding and shortening the operation time.In addition,LPG encourages food to pass through the gastric stump and duodenum,contributing to postoperative nutrient absorption.However,LPG is associated with the risk of postoperative reflux esophagitis,which reduces the postoperative quality of life of patients.There are differences between the two surgical methods,and no consensus has been reached.How to choose the right way of resection based on radical surgery will directly affect the postoperative treatment effect and quality of life of patients.The purpose of this paper is to integrate the domestic and foreign high-quality RCT,by meta analysis of large data contrast two operation method of postoperative reflux esophagitis,postoperative anastomotic stenosis,anastomotic fistula,intestinal obstruction,5-year survival rate of postoperative outcome indicators,cardia cancer study laparoscopic radical prostatectomy in these two kinds of operation method for patients with curative effect and the influence of quality of life.Objective:With reflux esophagitis,anastomotic fistula,5-year survival rate,anastomotic stenosis and intestinal obstruction as outcome indicators,the therapeutic effects of total gastrectomy and proximal gastrectomy for laparoscopic cardia cancer were systematically evaluated,so as to provide references for choosing appropriate surgical methods for advanced cardia cancer.Methods:The search terms were cardiac cancer,total gastrectomy,proximal gastrectomy,laparoscopic,etc.The combination of free word and subject word is set as the retrieval mode.Systematic literature retrieval was conducted in Pubmed,Cochrane Library,Web of sscience,Embase,Wan Fang Date and CNIK databases(up to September 2019).The Cochrane risk offset assessment tool and the newcastle-ottawa scale were used for quality evaluation.Rev Man 5.3 software was used for statistical analysis of data.The weighted mean difference(WMD)was used to analyze the continuous variables,and the odds ratio(OR)was used to analyze the binomial data.Subgroup analysis was used to assess potential sources of heterogeneity.Sensitivity analysis to assess the impact of individual studies on the overall assessment.Draw funnel plot to evaluate publication offset.Results:Finally,Sixteen references were included in this study.The total number of cases was 1726,including 858 cases in the laparoscopic total gastrectomy group and 868 cases in the laparoscopic proximal gastrectomy group.The results of meta-analysis showed that the incidence of reflux esophagitis decreased in laparoscopic cardia cancer resection compared with LPG(OR=0.23,95%ci: 0.11-0.49,P < 0.05).The 5-year survival rate of LTG increased(OR=1.73,95%ci: 1.33 ～ 2.25,P < 0.05).The incidence of anastomotic fistula in the two groups was not statistically significant(OR=0.70,95%ci: 0.39 ～ 1.25,P > 0.05).The incidence of anastomotic stenosis in the two groups was not statistically significant(OR=0.61,95%ci: 0.30-1.25,P > 0.05).The incidence of intestinal obstruction in the two groups was not statistically significant(OR=0.95,95%ci: 0.51 ～ 1.76,P > 0.05).According to the funnel plot results,there was little risk of publication bias in the included literature: most of the scattered points were distributed in the funnel and were symmetrically distributed on both sides of the vertical axis.Conclusions:According to the existing evidence for laparoscopic treatment of cardia cancer,proximal gastrectomy and total gastrectomy in postoperative anastomotic fistula,anastomotic stenosis and the incidence of intestinal obstruction,and for postoperative reflux esophagitis,5-year survival rate showed the advantages,total gastrectomy can obtain better long-dated curative effect,can further promote in clinical application. |
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