Background. Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer. Methods. Systematic review and randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG), laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size measures were the risk ratio (RR), the weighted mean difference (WMD), and the 95% credible intervals (CrIs). Results. Ten RCTs (3823 patients) were included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG, 1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe complications (Clavien–Dindo > 3), and in-hospital mortality were comparable. No differences were observed for reoperation rate, pulmonary complications, postoperative bleeding requiring transfusion, surgical-site infection, cardiovascular complications, number of harvested lymph nodes, and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG showed a significantly reduced intraoperative blood loss with a trend toward shorter time to first flatus and reduced length of stay. Conclusions. LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by dedicated surgeons have comparable short-term outcomes to Op-DG for locally AGC.
背景：针对局部进展期胃癌（AGC）的微创手术治疗仍存争议。本研究旨在对可切除远端胃癌的主要手术方式进行全面评估。方法：采用系统综述与随机对照试验（RCT）网络荟萃分析方法，比较开腹远端胃切除术（Op-DG）、腹腔镜辅助远端胃切除术（LapAs-DG）、全腹腔镜远端胃切除术（Lap-DG）及机器人辅助远端胃切除术（Rob-DG）。合并效应量指标包括风险比（RR）、加权均数差（WMD）及95%可信区间（CrIs）。结果：共纳入10项RCT研究（3823例患者），其中Lap-DG组1012例（26.5%）、LapAs-DG组902例（23.6%）、Op-DG组1768例（46.2%）、Rob-DG组141例（3.7%）。各组在吻合口漏、严重并发症（Clavien-Dindo分级>3级）及住院死亡率方面无显著差异。再手术率、肺部并发症、需输血的术后出血、手术部位感染、心血管并发症、淋巴结清扫数目及切缘阴性率等指标均未见统计学差异。与Op-DG相比，Lap-DG与LapAs-DG术中失血量显著减少，且呈现首次排气时间缩短及住院时间减少的趋势。结论：在专科医疗中心由经验丰富的外科医师实施时，LapAs-DG、Lap-DG及Rob-DG治疗局部进展期胃癌的短期疗效与Op-DG相当。
肿瘤(癌症)患者之家