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. 2022 Nov 7;30(1):4-19.
doi: 10.1159/000526644. eCollection 2023 Jan.

Efficacy and Safety of Laparoscopic Endoscopic Cooperative Surgery in Upper Gastrointestinal Lesions: A Systematic Review and Meta-Analysis

Sara Oliveira de Brito  1 , Diogo Libânio  2   3 , Cláudia Martins Marques Pinto  2 , João Pedro Pinho Osório de Araújo Teixeira  4   5 , João Paulo Meireles de Araújo Teixeira  4   5
Affiliations

Efficacy and Safety of Laparoscopic Endoscopic Cooperative Surgery in Upper Gastrointestinal Lesions: A Systematic Review and Meta-Analysis

Sara Oliveira de Brito et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Background and aims: Laparoscopic and endoscopic cooperative surgery (LECS) combines advantages of endoscopy and laparoscopy in order to resect upper gastrointestinal lesions. Our aim was to evaluate the efficacy and safety of LECS in patients with EGJ (esophagogastric junction), gastric and duodenal lesions, as well as to compare LECS with pure endoscopic and pure laparoscopic procedures.

Methods: PubMed, Scopus, and ISI Web of Knowledge were searched. Efficacy (R0, recurrence) and safety (conversion rate, procedure and hospitalization time, adverse events, mortality) outcomes were extracted and pooled (odds ratio or mean difference) using a random-effects model. Study quality was assessed with Newcastle-Ottawa Scale and heterogeneity by Cochran's Q test and I2 . Subgroup analysis according to location was performed.

Results: This meta-analysis included 24 studies/1,336 patients (all retrospective cohorts). No significant differences were found between LECS and preexisting techniques (endoscopic submucosal dissection (ESD)/laparoscopy) regarding any outcomes. However, there was a trend to shorter hospitalization time, longer procedure duration, and fewer adverse events in LECS versus Laparoscopy and ESD. R0 tended to be higher in the LECS group. Hospitalization time was significantly shorter in gastric versus EGJ lesions (mean 7.3 vs. 13.7 days, 95% CI: 6.6-7.9 vs. 8.9-19.3). There were no significant differences in conversion rate, adverse events, or mean procedural time according to location. There was a trend to higher conversion rate and longer procedure durations in EGJ and higher rate of adverse events in duodenal lesions.

Conclusion: LECS is a valid, safe, and effective treatment option in patients with EGJ, gastric, and duodenal lesions, although existing studies are retrospective and prone to selection bias. Prospective studies are needed to assess if LECS is superior to established techniques.

Key messages: LECS is safe and effective in the treatment of upper gastrointestinal lesions, but there is no evidence of superiority over established techniques.

Introdução e objetivos: A Cirurgia cooperativa laparoscópica e endoscópica (LECS) combina vantagens da endoscopia e laparoscopia na resseção de lesões gastrointestinais superiores. O nosso objetivo é avaliar a eficácia e segurança da LECS em pacientes com lesões na junção esofagogástrica (EGJ), estômago e duodeno, e comparar a LECS com procedimentos puramente endoscópicos e laparoscópicos.

Métodos: PubMed, Scopus, ISI Web of Knowledge foram pesquisadas. Dados sobre eficácia (R0, recorrência) e segurança (taxa de conversão, duração do procedimento e hospitalização, recorrência, eventos adversos, mortalidade) foram colhidos e agrupados (odds ratio ou média das diferenças), usando modelo de efeitos randomizados. Qualidade dos estudos foi avaliada pela Escala Newcastle-Ottawa e heterogeneidade pelos testes Q da Cochran e I2. Foi realizada análise de subgrupos, consoante a localização.

Resultados: Esta meta-análise incluiu 24 estudos/1336 pacientes (todos coortes retrospetivos). Não encontramos diferenças significativas entre LECS e as técnicas pré-existentes (Disseção endoscópica da submucosa (ESD)/Laparoscopia) em nenhum aspeto. Porém, encontramos uma tendência para hospitalização mais curta, procedimentos mais longos e menos efeitos adversos na LECS versus Laparoscopia e ESD. R0 tende a ser maior no grupo LECS. Hospitalização foi significativamente menor em lesões gástricas versus EGJ (média 7.3 vs. 13.7 dias, 95% CI: 6.6–7.9 vs. 8.9–19.3). Não encontramos diferenças significativas na taxa de conversão, eventos adversos nem tempo médio de procedimento. Porém encontramos uma tendência para taxas de conversão maiores e procedimentos mais longos na EGJ e maior taxa de eventos adversos no duodeno.

Conclusão: LECS é um tratamento válido, seguro e eficaz em pacientes com lesões na EGJ, estômago e duodeno, apesar dos estudos retrospetivos existentes estarem propensos a viés de seleção. São necessários estudos prospetivos para avaliar a superioridade da LECS face às técnicas existentes.

Mensagens-chave: LECS é um tratamento seguro e eficaz para lesões gastrointestinais superiores, mas sem evidência de superioridade face às técnicas existentes.

Keywords: Endoscopic submucosal dissection; Laparoscopic endoscopic cooperative surgery; Laparoscopic resection; Meta-analysis; Subepithelial lesions.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart of included studies. LECS, laparoscopic and endoscopic cooperative surgery.
Fig. 2
Fig. 2
a–g Forest plots of several outcomes according to surgical technique. a Forest plot of procedure time according to surgical technique (Laparoscopic Techniques vs. LECS). b Forest plot of hospitalization time according to surgical technique (Laparoscopic Techniques vs. LECS). c Forest plot of adverse event according to the surgical technique (Laparoscopic Techniques vs. LECS). d Forest plot of R0 according to the surgical technique (ESD vs. LECS). e Forest plot of procedure time according to the surgical technique (ESD vs. LECS). f Forest plot of hospitalization time according to the surgical technique (ESD vs. LECS). g Forest plot of adverse event according to the surgical technique (ESD vs. LECS). LECS, laparoscopic and endoscopic cooperative surgery; ESD, endoscopic submucosal dissection; SD, standard deviation.
Fig. 3
Fig. 3
a−d Rates of conversion and adverse events according to location (gastric, EGJ, and duodenal). Forest plots of mean hospitalization time and mean procedure time according to the location (gastric, EGJ and duodenal). a Rates of conversion according to the location (gastric, EGJ, and duodenal). b Rates of adverse events according to the location. c Forest plots of mean hospitalization time according to the location (gastric, EGJ, and duodenal). d Forest plots of mean procedure time according to the location (gastric, EGJ, and duodenal). EGJ, esophagogastric junction.
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