The Efficacy And Safety Between Laparoscopic Proximal Gastrectomy And Total Gastrectomy For Proximal Gastric Cancer:A Meta-analysis

Objectives To investigate the efficacy and safety of Laparoscopic Proximal Gastrectomy(LPG)and Laparoscopic Total Gastrectomy(LTG)in the treatment of proximal gastric cancer.Methods Computer search and collection of Pub Med,Embase,Cochrane Library,China National Knowledge Network(CNKI),Wanfang database from 1980 to September 2020 compared LPG and LTG treatment of proximal gastric cancer literatures.According to the inclusion and exclusion criteria gradually strict screening of the literature.The NOS was used to evaluate the proposed literatures.Extracted into the literature of various indicators,including the author,year of publication,study age,country,number of cases,age,gender,tumor size,tumor stage,operative time,blood loss,lymph node dissection,Duration of postoperative hospital stay,reflux,anastomotic stenosis,anastomotic leakage,intestinal obstruction,infections,the total complication rate,nutrition indicators.The use finishing literature of Endnote X9.Revman 5.3.5 was used for data analysis.Results Finally,20 articles were included.Among them,there are 6 articles about stage I proximal gastric cancer.In operable proximal gastric cancer,the tumor’s diameter in the LPG group was inferior to that in the LTG group[WMD=-0.78,95%CI(-1.30,-0.26),P=0.003];the scope of lymph node dissections in the LPG group was significantly less than that in the LTG group[WMD=-0.62,95%CI(-0.96,-0.28),P<0.01];the incidence of reflux in the LPG group was superior to that in the LTG group[OR=3.82,95%CI(2.51,5.82),P<0.01];the incidence of anastomotic stenosis in the LPG group was above that in the LTG group[OR=1.69,95%CI(1.05,2.70),P=0.03];the three-year survival rate of the LPG group,Five-year survival rate,average age,operation time,intraoperative blood loss,postoperative exhaust time,postoperative hospitalization days,postoperative intestinal obstruction incidence,postoperative abdominal infection incidence,and total The complication rate was no different from LTG(P>0.05).The vitamin B12 deficiency rate in the LPG group was inferior to that in the LTG group[OR=0.06,95%CI(0.01,0.59),P=0.02].In stage I proximal gastric cancer,the intraoperative blood loss of the LPG group was superior to that of the LTG group[WMD=-45.18,95%CI(-83.69,-6.66),P=0.02];the number of lymph node dissections in the LPG group was significantly less than that of the LTG group Group[WMD=-14.86,95%CI(-29.30,-0.43),P=0.04];the incidence of anastomotic stenosis in the LPG group was above that in the LTG group[OR=2.75,95%CI(1.28,5.93),P=0.01];in average age,operation time,maximum tumor diameter,postoperative exhaust time,postoperative hospital stay,postoperative reflux esophagitis incidence,postoperative anastomotic leakage incidence,postoperative bowel The incidence of obstruction and postoperative abdominal infection were the same as LTG(P>0.05).Conclusion LTG is more effective and safer than LPG in the proximal gastric cancer.Figure 20;Table 8;Reference 192...