| Research purpose:1.Using meta-analysis system to evaluate the long-term effect of laparoscopic and open total gastrectomy in the treatment of advanced gastric cancer,and to determine whether laparoscopic total gastrectomy and open surgery are the factors influencing the long-term prognosis of gastric cancer patients.2.By sorting out and analyzing the clinical data,the influence of preoperative body mass index(BMI)on the long-term survival of laparoscopic D2 gastrectomy was clarified.Research methods:1.First of all,with "advanced gastric cancer","laparoscopy","laparotomy" and"survival rate" as Chinese search terms,search the published Chinese literature in Wanfang medical network database,CNKI and other Chinese databases;secondly,use "advanced gastric cancer","laparoscopy","laparotomy "," survival rate " as English search terms for searching English literature published on English databases such as PubMed,EMBASE and web of science.The literature about laparoscopic total gastrectomy in the treatment of advanced gastric cancer and laparotomy were extracted.The limited languages are Chinese and English.According to the inclusion and exclusion criteria,the relevant literature was screened and the quality of literature was evaluated.The survival status of patients in two groups after total gastrectomy,and all the data were meta-analyzed with RevMan 5.3 software.Inclusion criteria:(1)subjects have been identified as advanced gastric cancer by endoscopy and biopsy;(2)subjects have undergone total gastrectomy with D2 lymphadenectomy,and can extract effective data;(3)literature is a comparative study of clinical efficacy between laparoscopic group and open group;(4)literature can extract relevant indicators of patients’ survival after total gastrectomy,such as overall survival rate and disease-free survival rate after operation;(5)published Chinese or English literature.Exclusion criteria:(1)the subjects in the literature were diagnosed as gastric benign tumors;(2)In addition to gastric cancer,the subjects also had tumor diseases in other parts;(3)recurrent gastric cancer;(4)Although laparoscopic group and laparotomy group were compared in the literature,the data related to distal and proximal stomach were involved,and the effective data of total gastrectomy could not be extracted;(5)the subjects had distant metastasis or invasion of surrounding organs,but could not undergo radical gastrectomy;(6)the subjects had recurrent gastric cancer subjects received palliative surgery without radical surgery;(7)repeated,unpublished or missing data;(8)non Chinese or English literature.2.The clinical data of 66 cases of gastric cancer diagnosed in general surgery of 960 Hospital of PLA(former General Hospital of Jinan Military Region)from 2009 to 2014 were analyzed retrospectively.The main outcome measure was the 5-year overall survival of patients with gastric cancer.All gastric cancer patients were divided into three groups according to body mass index.First,according to WHO standard[1]Asian standard[2]and Chinese standard[3-4],all patients with gastric cancer were divided into low body mass index group,normal group,super recombination group and obesity group.Secondly,according to WHO standard,Asian standard and Chinese standard,all gastric cancer patients were divided into normal body mass index group and abnormal body mass index group(including low body mass index group,super recombination group and obesity group).Finally,according to Asian standard and Chinese standard,patients with body mass index higher than 18.5kg/m2 were divided into normal body mass index group and high body mass index group(including super recombination and obesity group).Kaplan-Meier method was used for survival analysis,and log-rank test was used to compare the survival rate among groups.The clinical and pathological characteristics of the groups with statistical significance were compared.Single factor analysis and Cox proportional risk model multi factor analysis were conducted for all the observed indicators.Inclusion criteria:(1)preoperative CT,pathological examination or gastroscopy were performed to confirm the diagnosis of gastric cancer and exclude other organ tumor diseases;(2)no chemotherapy and other related treatment was performed before operation;(3)no distant metastasis,abdominal metastasis and invasion of surrounding tissues and organs were found in preoperative examination and intraoperative exploration;(4)laparoscopic D2 radical gastrectomy was performed in patients,including distal gastrectomy and total gastrectomy did not switch to open surgery during the operation;(5)the survival time information was complete;(6)the patient’s pathological report and medical record and other clinical data were complete;(7)the cause of death of the patient was recurrence of gastric cancer or related complications death(relevant information was obtained mainly from family members through telephone follow-up,or by querying the relevant inpatient medical record).Exclusion criteria:(1)the pathological report and medical record of patients with gastric cancer are incomplete;(2)the patients are benign tumors or recurrent gastric cancer;(3)the patients are complicated with tumor diseases in other parts;(4)palliative operation is performed when distant metastasis,abdominal cavity metastasis or invasion of surrounding tissues and organs are found in preoperation or intraoperative exploration;(5)other organs are removed during operation;(6)transit laparotomy.Results:1.1.There are 9 related studies in total,2 of which are excluded due to the inability to extract effective data,so there are 7 related studies,including 5 in English and 2 in Chinese.A total of 2142 patients were included in the study,which were divided into laparoscopic group(709 cases)and open group(1433 cases).Meta analysis showed that the 5-year overall survival rate(OR=1.09,95%CI:0.89-1.33,P=0.41),the 3-year-disease-free survival rate(OR=0.84,95%CI:0.55-1.30,P=0.44)and 5-year-disease-free survival rate(OR=1.14,95%CI:0.91-1.41,P=0.25).There was no significant difference of those groups.2.From June 2009 to December 2019,66 patients with gastric cancer undergoing laparoscopic D2 gastrectomy were included in the study.The difference of Asian standard classification between normal body mass index group and abnormal body mass index group(low body mass index,overweight and obesity group)has statistical significance on the OS of gastric cancer patients 5 years after operation(P=0.018).The difference between the normal body mass index group and the abnormal body mass index group(low body mass index,overweight and obesity group)according to the Chinese standard classification has a statistically significant effect on the OS of patients with gastric cancer 5 years after operation(P=0.036).The difference of Asian standard classification between normal body mass index group and the high BMI group(overweight and obesity group)has statistical significance on the OS of gastric cancer patients 5 years after operation(P=0.030).There was no significant difference in the clinicopathological characteristics of the above groups.Single factor analysis showed that pathological stage(P=0.003),tumor invasion depth(P=0.049),lymph node metastasis(0.043)and BMI Asian classification standard(P=0.018)were the factors influencing the long-term survival of laparoscopic D2 gastrectomy.Multivariate analysis of Cox proportional risk model showed that pathological staging was an independent risk factor for the long-term survival of laparoscopic D2 gastrectomy.Conclusion:1.Laparoscopic total gastrectomy can achieve the same long-term effect as open surgery in the treatment of gastric cancer patients,and it has been confirmed that laparoscopic distal gastrectomy can achieve the same effect as open surgery[5].Therefore,laparoscopic D2 radical gastrectomy(total gastrectomy and distal gastrectomy)and open surgery are not one of the factors affecting the long-term prognosis of gastric cancer patients.2.In laparoscopic D2 gastrectomy(total gastrectomy and distal gastrectomy),preoperative body mass index(Asian standard)is an important factor affecting the overall survival of 5 years after operation.The overall 5-year survival rate of patients with preoperative high body mass index(23.0 kg/m2≤BMI)is higher than that of patients with normal body mass index(18.5 kg/m2≤BMI≤22.9 kg/m2).In laparoscopic D2 gastrectomy,pathological stage,depth of tumor invasion,lymph node metastasis and Asian body mass index classification are the factors influencing the long-term survival of gastric cancer patients.Pathological staging is an independent risk factor for the long-term survival of laparoscopic D2 gastrectomy,and with the increase of pathological staging,the risk of death is gradually increasing. |
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