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Endoscopy vs surgery in the treatment of early gastric cancer:Systematic review

World Journal of Gastroenterology 2015年第46期21卷 13177-13187页

作者： André Kondo Eduardo Guimaraes Hourneaux de Moura Wanderley Marques Bernardo osmar kenji yagi Diogo Turiani Hourneaux de Moura Eduardo Turiani Hourneaux de Moura José Gon?alves Pereira Bravo Kendi Yamazaki Paulo Sakai Gastrointestinal Endoscopy Division Department of GastroenterologyHospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo Guidelines Program Coordinator Brazilian Medical Association (AMB) Gastrointestinal Surgery Division Sao Paulo State Cancer Institute (ICESP)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo

AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical ***: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were ***: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P < 0.05),demonstrating better results with endoscopy. Mortality data were

关键词： Gastric cancer Endoscopy Gastroscopy Gastrectomy Surgery Systematic review

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