Luigi Marano1, Karol Polom2, Alberto Bartoli1, Alessandro Spaziani1, Raffaele De Luca3, Laura Lorenzon4, Natale Di Martino5, Daniele Marrelli2, Franco Roviello2, Giampaolo Castagnoli1. 1. a General, Minimally Invasive and Robotic Surgery, Department of Surgery , " San Matteo degli Infermi Hospital "-ASL Umbria 2, Spoleto ( PG ), Italy. 2. b Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery , University of Siena , Viale Bracci, Italy. 3. c Department of Surgical Oncology , National Cancer Research Centre-Istituto Tumori "G. Paolo II" , Bari , Italy. 4. d Surgical and Medical Department of Translational Medicine , University of Rome "La Sapienza", Sant'Andrea Hospital of Rome , Rome , Italy. 5. e Department of Surgical Sciences , Second University of Naples , Naples , Italy.
Abstract
Purpose/Aim: In the past few decades some researchers have questioned whether bursectomy for gastric cancer is essential from an oncological point of view and no consistent recommendations have been proposed. The aim of this systematic review with meta-analysis is to investigate the oncologic effectiveness and safety of bursectomy for the treatment of advanced gastric cancer patients. MATERIALS AND METHODS: We planned and performed this systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and Cochrane Handbook for Systematic Reviews of Intervention. RESULTS: Overall, four studies with a total of 1,340 patients met inclusion criteria. The pooled hazard ratio for overall survival between the bursectomy versus nonbursectomy groups was [HR = 0.85, 95% CI 0.66-1.11, p =.252]. Interestingly, the pooled HR between the two groups in serosa-positive cases subgroup, showed a significant improvement of overall survival rate in favor of bursectomy [HR = 0.72, 95% CI 0.73-0.99, p <.05]. CONCLUSIONS: Bursectomy represents a surgical procedure that might be able to improve overall survival in serosa positive gastric cancer patients. However, a definitive conclusion could not be made because of the studies' methodological limitations. This meta-analysis points to the urgent need of high quality, large-scaled, clinical trials with short- as well as long-term evaluation comparing bursectomy with non bursectomy procedures, in a controlled randomized manner, helping future researches and establishing a modern and tailored approach to gastric cancer.
Purpose/Aim: In the past few decades some researchers have questioned whether bursectomy for gastric cancer is essential from an oncological point of view and no consistent recommendations have been proposed. The aim of this systematic review with meta-analysis is to investigate the oncologic effectiveness and safety of bursectomy for the treatment of advanced gastric cancerpatients. MATERIALS AND METHODS: We planned and performed this systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and Cochrane Handbook for Systematic Reviews of Intervention. RESULTS: Overall, four studies with a total of 1,340 patients met inclusion criteria. The pooled hazard ratio for overall survival between the bursectomy versus nonbursectomy groups was [HR = 0.85, 95% CI 0.66-1.11, p =.252]. Interestingly, the pooled HR between the two groups in serosa-positive cases subgroup, showed a significant improvement of overall survival rate in favor of bursectomy [HR = 0.72, 95% CI 0.73-0.99, p <.05]. CONCLUSIONS: Bursectomy represents a surgical procedure that might be able to improve overall survival in serosa positive gastric cancerpatients. However, a definitive conclusion could not be made because of the studies' methodological limitations. This meta-analysis points to the urgent need of high quality, large-scaled, clinical trials with short- as well as long-term evaluation comparing bursectomy with non bursectomy procedures, in a controlled randomized manner, helping future researches and establishing a modern and tailored approach to gastric cancer.