Endoscopic Submucosal Dissection Versus Surgery or Endoscopic Mucosal Resection for Metachronous Early Gastric Cancer: a Meta-analysis

被引：5

作者：

Meng, Zhao Wu ^{[1
,2
]}

Bishay, Kirles ^{[1
,2
]}

Vaska, Marcus ^{[3
]}

Ruan, Yibing ^{[4
,5
]}

Al-Haddad, Mohammad A. ^{[6
]}

Elhanafi, Sherif E. ^{[7
]}

Qumseya, Bashar J. ^{[8
]}

Belletrutti, Paul J. ^{[1
]}

Gill, Richdeep ^{[9
]}

Debru, Estifanos ^{[9
]}

Heitman, Steven J. ^{[1
,2
]}

Brenner, Darren R. ^{[2
,4
,5
]}

Forbes, Nauzer ^{[1
,2
]}

机构：

[1] Univ Calgary, Dept Med, Div Gastroenterol & Hepatol, CWPH 6D19,3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada

[2] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada

[3] Alberta Hlth Serv, Knowledge Resource Serv, Calgary, AB, Canada

[4] Univ Calgary, Cumming Sch Med, Dept Oncol, Calgary, AB, Canada

[5] Alberta Hlth Serv, Dept Canc Epidemiol & Prevent Res Canc Control Alb, Calgary, AB, Canada

[6] Indiana Sch Med, Div Gastroenterol, Indianapolis, IN USA

[7] Texas Tech Univ, Dept Internal Med, Paul L Foster Sch Med, El Paso, TX USA

[8] Univ Florida, Dept Gastroenterol, Gainesville, FL USA

[9] Univ Calgary, Dept Surg, Calgary, AB, Canada

来源：

JOURNAL OF GASTROINTESTINAL SURGERY | 2023年 / 27卷 / 11期

关键词：

Endoscopic submucosal dissection; Gastric cancer; Surgery; Endoscopic mucosal resection; LONG-TERM OUTCOMES; LOCALLY RECURRENT; MARGINS;

D O I：

10.1007/s11605-023-05840-4

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BackgroundResection options for early gastric cancer (EGC) include endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and surgery. In patients with metachronous EGC following previous resection, the optimal resection technique is not well elucidated. We conducted a systematic review and meta-analysis of studies comparing ESD to EMR, or ESD to surgery, in patients with metachronous EGC.MethodsWe conducted an electronic search of studies reporting on outcomes and AEs following ESD versus either EMR or surgery for patients with metachronous EGC. Pooled odds ratios (OR) of included studies were obtained using DerSimonian and Laird random effects models. Funnel plots were produced and visually inspected for evidence of publication bias. The quality of the evidence was assessed using GRADE.ResultsA total of 9367 abstracts were screened and 10 observational studies were included. The odds of complete resection were higher amongst patients undergoing ESD compared to EMR (OR 5.88, 95% confidence intervals, CI, 1.79-19.35), whereas the odds of complete resection were no different between ESD and surgery (OR 0.57, 95% CI 0.04-8.24). There were no differences in the odds of local recurrence with ESD versus surgery (OR 5.01, 95% CI 0.86-29.13). Post-procedural bleeding did not differ significantly between ESD and EMR (OR 0.70, 95% CI 0.16-3.00). There was no evidence of publication bias.DiscussionFor metachronous EGC, ESD or surgery is preferred over EMR depending on local expertise and patient preferences, largely due to a higher risk of incomplete resection with EMR.Review RegistrationPROSPERO CRD42021270445.

引用

页码：2628 / 2639

页数：12