RESUMO
Background: Endoscopic resection (ER) and gastrectomy have been both accepted as curative treatments for early gastric cancer. We intended to compare ER with gastrectomy treatments on safety of patients, disease-free survival and overall survival for early gastric cancer through this systematic review. Methods: A literature search was performed in Pubmed, Embase, and Cochrane Library databases. Studies that have compared ER with gastrectomy for early gastric cancer were included in this meta-analysis. We searched for clinical studies published before March 2019. Stata 12.0 software was used for systematic analysis. Results: Nine studies were included in this systematic review, ER treatment was associated with a shorter length of stay (WMD = -8.53, 95% CI -11.56 to -5.49), fewer postoperative complications (OR = 0.47, 95% CI 0.34-0.65). ER can be performed safely with shorter hospital stay and fewer postoperative complications than gastrectomy. Recurrence rate was higher for ER than for gastrectomy treatment (HR = 3.56, 95% CI 1.86-6.84), mainly because metachronous gastric cancers developed only in the ER treatment. However, most of the metachronous gastric cancers could be curatively treated with ER again, and it didn't affect overall survival of patients with early gastric cancer. There was no difference in overall survival rate between ER and gastrectomy (HR = 0.84, 95% CI 0.63-1.13). Conclusions: ER and gastrectomy are both acceptable for curative treatment of early gastric cancer. However, due to the comparable overall survival and lower postoperative complications and shorter length of stay, ER is better than gastrectomy for early gastric cancer, who met the indication for ER treatment.
RESUMO
BACKGROUND: It is now recognized that Cimicifuga foetida (C. foetida) extract is effective in alleviating menopausal symptoms. But the durations reported were usually short. The aim of this study was to investigate the effects of C. foetida extract therapy and different estrogen and progesterone sequential therapies, on the breasts of early postmenopausal women. METHODS: This was a prospective randomized trial. Ninety-six early menopausal women were recruited and randomly assigned into three groups treated with different therapies for 2 years. Patients were given C. foetida extract in Group A, estradiol valerate and medroxyprogesterone acetate in Group B, and estradiol valerate and progesterone in Group C. Ultrasonography was used to monitor changes in breast during treatment. RESULTS: In comparing breast glandular section thickness before and after 1 and 2 years of treatment, no significant difference was observed in Group A (11.97 ± 2.84 mm vs. 12.09 ± 2.58 mm and 12.61 ± 3.73 mm, P > 0.05); in Group B glandular section thickness had increased significantly (10.98 ± 2.34 mm vs. 11.84 ± 2.72 mm and 11.90 ± 3.33 mm, P < 0.05) after treatment, the same as Group C (11.56 ± 3.03 mm vs. 12.5 ± 3.57 mm and 12.22 ± 4.39 mm P < 0.05). In comparing breast duct width before and after 1 and 2 years of treatment, no significant difference was seen in Group A (1.07 ± 0.19 mm vs. 1.02 ± 0.18 mm and 0.98 ± 0.21 mm, P > 0.05); in Group B the duct width had a downward trend after treatment (0.99 ± 0.14 mm vs. 0.96 ± 0.22 mm and 0.90 ± 0.18 mm, P < 0.05), the same as Group C (1.07 ± 0.20 mm vs. 1.02 ± 0.17 mm and 0.91 ± 0.19 mm, P < 0.05). The nodules detected before treatment had disappeared after 1-year of treatment or exhibited no distinct changes in the three groups. However, new breast nodules had appeared after 2 years of treatment: There was one case in Group A, two cases in Group B and four cases in Group C, with breast hyperplasia after the molybdenum target check. CONCLUSIONS: In early postmenopausal patients, C. foetida extract therapy and estrogen and progesterone therapy at low doses did not increase the incidence of malignant breast tumors.