Meta-analysis Of Surgical Safety Comparison Between Laparoscopic Proximal Gastrectomy And Total Gastrectomy For Early Proximal Gastric Cancer

Purpose: By comparing the safety of Laparoscopic proximal gastrectomy(LPG)and total gastrectomy(LTG)for early proximal gastric cancer,To provide the basis for the selection of surgical methods for the treatment of early proximal gastric cancer.Method: Retrieved and collected from CNKI,Wanfang,VIP,Pubmed,Embase,Cochare library and Web of China A comparative study of laparoscopic proximal gastrectomy(LPG)and laparoscopic total gastrectomy(LTG)in the treatment of early proximal gastric cancer published in science from 2011 to 2021.Literature was screened according to inclusion criteria and exclusion criteria,and high-quality literature was further screened using the corresponding literature quality evaluation scale.General data(author,publication time,number of cases,number of complications)were extracted from the finally included literature.Intraoperative data(operation time,intraoperative blood loss,dissection of lymph nodes);Postoperative data(overall postoperative complications,reflux esophagitis,abdominal infection,anastomotic fistula,anastomotic stricture,anastomotic bleeding,intestinal obstruction,pancreatic fistula,first exhaust time,postoperative hospital stay)were Meta-analyzed based on the extracted data.Results: Fifteen literatures were included(all retrospective studies).Meta analysis showed that: Operative time(WMD=-2.60,95%CI=-17.14-11.94,P=0.73),overall incidence of postoperative complications(OR=0.62,95%CI=0.36-1.09,P=0.10),incidence of postoperative reflux esophagitis(OR=1.14,95%CI= 0.38-3.39,P=0.10),incidence of abdominal infection(OR=1.67,95%CI= 0.80-3.50,P=0.17),incidence of anastomotic fistula(OR=1.29,95%CI=0.63-2.63,P=0.49),incidence of anastomotic stenosis(OR=1.28,95%CI=0.80-2.04,P=0.30),incidence of anastomotic bleeding(OR=1.52,95%CI=0.25-9.17,P=0.65),incidence of intestinal obstruction(OR=0.52,95%CI=0.23～ 1.20,P=0.12),pancreatic fistula incidence(OR=1.32,95%CI=0.49 ～ 3.52,P=0.58),first postoperative exhaust time(WMD=-0.01,95%CI=-0.44 ～ 0.24,P=0.57)and postoperative hospital stay(WMD=-0.49,95%CI=-2.06-1.08,P=0.54)was not statistically significant.The intraoperative bleeding amount(WMD=-14.63,95%CI=-28.93-0.32,P=0.05)and the number of lymph nodes dissected(WMD=-8.27,95%CI=-12.87-4.07,P=0.0002)was statistically different between the two groups.Intraoperative bleeding in the LPG group was less than that in the LTG group.The number of lymph nodes dissected in LTG group was higher than that in LPG group.Abstract text generally does not exceed 3000 words.Conclusion: Both laparoscopic proximal gastrectomy(LPG)and laparoscopic total gastrectomy(LTG)are suitable for the treatment of early proximal gastric cancer,and there is no significant difference in surgical safety between them.However,more research data are needed to confirm whether there are differences in the effects of the two surgical methods on long-term complications and overall survival.