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Comparison of estimated treatment effects between randomized controlled trials, case-matched, and cohort studies on laparoscopic versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
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Abstract

Purpose

In actual surgical research, case-matched studies are frequently conducted as an alternative to randomized controlled trials (RCTs). However, it is still unclear what differences there are between RCTs and case-matched studies in upper gastrointestinal surgery, and clarifying them is a very important clinical issue. Thus, the purpose of this study was to investigate estimated treatment effects between RCTs, case-matched studies, and cohort studies regarding laparoscopic distal gastrectomy (LDG) for advanced gastric cancer (AGC).

Methods

We searched the PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases for studies that compared LDG versus open distal gastrectomy for AGC published from the inception of the databases until July 2021. A meta-analysis was performed using the Review Manager version 5.3 software program from the Cochrane Collaboration, and six short-term outcomes and three long-term outcomes were assessed.

Results

Twenty-three studies with 13698 patients were included. There was no difference in estimated treatment effects between RCTs and case-matched studies for all outcomes except for the number of retrieved lymph nodes and postoperative complications. In terms of intraoperative blood loss, postoperative hospital stay, number of retrieved lymph nodes, and recurrence, observational studies tended to overestimate the treatment effects.

Conclusion

The estimated treatment effects of LDG for AGC in the case-matched study were almost the same as in the RCTs. However, to assess the true magnitude of the treatment effect, the design and actual implementation of the analysis must be critically evaluated.

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Authors and Affiliations

  1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan

    Ryota Otsuka, Hideki Hayashi, Masaya Uesato, Koichi Hayano, Kentaro Murakami, Masayuki Kano, Takeshi Toyozumi, Hiroshi Suito, Yasunori Matsumoto, Tetsuro Isozaki, Yoshihiro Kurata & Hisahiro Matsubara

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  1. Ryota Otsuka
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  2. Hideki Hayashi
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Contributions

Ryota Otsuka conceived and designed the study. Yasunori Matsumoto and Ryota Otsuka performed the literature search and data acquisition. Takashi Toyozumi, Hiroshi Suito, Tetsuro Isozaki, Yoshihiro Kurata, and Ryota Otsuka contributed to the data analysis and interpretation. The manuscript was prepared by Ryota Otsuka under the supervision of Hideki Hayashi, Masaya Uesato, Koichi Hayano, Kentaro Murakami, Masayuki Kano, and Hisahiro Matsubara. All authors read and approved the final manuscript.

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Correspondence to Ryota Otsuka.

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Otsuka, R., Hayashi, H., Uesato, M. et al. Comparison of estimated treatment effects between randomized controlled trials, case-matched, and cohort studies on laparoscopic versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 407, 1381–1397 (2022). https://doi.org/10.1007/s00423-022-02454-3

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