Supplementary Material for: Laparoscopic versus open approach for Siewert-type II/III adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis

Introduction Due to the specific location, the potential advantages of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for Siewert II/III adenocarcinoma of the esophagogastric junction (AEG) remain uncertain. The current study aimed to compare the short- and long-term outcomes of LG versus OG in treating Siewert type II/III adenocarcinoma. Methods We searched PubMed, Embase, Web of Science, Medline (hosted by Ovid), and the Cochrane Library for publications, till July 2022 and then used the Revman5.3 software for statistical analysis. Results Ten publications from 10 medical centres were included, with 1516 cases from the LG group and 1219 from the OG group. Meta-analysis results showed that the LG group was superior to the OG group in intraoperative blood loss, hospital stay, lymph nodes retrieved, time to ambulation, time to first flatus, time to diet, 5-year overall survival, and 5-year disease-free survival. There was no significant difference between the two groups in operative time, overall complications, proximal margin, distal margin, pulmonary infection, anastomotic leakage, mortality, ileus, or absolute infection. Conclusions Compared with OG, LG is associated with better surgical and long-term outcomes in Siewert type II/III AEG. LG is a safe and feasible option for treating Siewert type II/III AEG. However, studies with large sample sizes, long follow-up periods, and rigorous designs are needed for verification.

引言 由于特殊的解剖位置，腹腔镜胃切除术（laparoscopic gastrectomy, LG）对比开腹胃切除术（open gastrectomy, OG）治疗食管胃结合部腺癌（adenocarcinoma of the esophagogastric junction, AEG）Siewert Ⅱ/Ⅲ型的潜在优势仍不明确。本研究旨在对比LG与OG治疗Siewert Ⅱ/Ⅲ型食管胃结合部腺癌的短期与远期结局。方法 我们检索了截至2022年7月的PubMed、Embase、Web of Science、Ovid平台收录的Medline以及Cochrane图书馆的相关文献，并采用Revman5.3软件进行统计分析。结果 共纳入10家医疗中心的10项研究，其中腹腔镜胃切除术组1516例，开腹胃切除术组1219例。Meta分析（meta-analysis）结果显示，腹腔镜胃切除术组在术中失血量、住院时长、获取淋巴结数目、首次下床活动时间、首次排气时间、首次进食时间、5年总生存率及5年无病生存率方面均优于开腹胃切除术组。两组在手术时长、总并发症发生率、近端切缘、远端切缘、肺部感染、吻合口漏、病死率、肠梗阻以及绝对感染方面均无显著差异。结论 相较于开腹胃切除术，腹腔镜胃切除术用于治疗Siewert Ⅱ/Ⅲ型食管胃结合部腺癌可获得更优的手术及远期结局，是一种安全可行的治疗方案。但仍需开展大样本、长随访周期且设计严谨的研究予以验证。