Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Abstract

Background Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. Methods Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. Results Overall, 26 studies were included in this metaanalysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P \ 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P \ 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P \ 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P \ 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P \ 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. Conclusions For AGCs, LG appeared comparable with OG in short-and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.

Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

“…Laparoscopic surgery has the potential benefit of decreased postoperative morbidity and reduced recovery time. Although concerns existed regarding the possibility of a reduced nodal harvest with a laparoscopic approach, a recent meta-analysis suggests that lymph node yields are comparable for both approaches [30]. Trials from the Far East have reported equivalent results to open surgery for distal gastrectomy, but there remain some technical issues particularly for anastomosis for total gastrectomy [31,32].…”

Management of advanced gastric cancer: An overview of major findings from meta-analysis

“…Nine meta-analyses compared the outcomes of LG versus OG [12, 13, 17, 26, 27, 29, 34, 38, 45]. There were 2, 5, and 3 meta-analyses comparing the 1-, 3-, 5-year survival, respectively [13, 17, 26, 27, 34].…”

“…There were 2, 5, and 3 meta-analyses comparing the 1-, 3-, 5-year survival, respectively [13, 17, 26, 27, 34]. Another two meta-analyses reported the overall survival (OS) without detailed time points [29, 45].…”

“…Another two meta-analyses reported the overall survival (OS) without detailed time points [29, 45]. The meta-analyses all demonstrated that the OS was statistically similar between LG and OG [13, 17, 26, 27, 29, 34, 45]. Two of them did not report OS [12, 38].…”

Influence of Visceral Fat on Early Postoperative Outcomes After Distal and Total Gastrectomy for Gastric Cancer

“…5 At our institution, a laparoscopic gastrectomy is performed only in patients with early gastric cancer, and accumulation of results in enough patients is not yet available for analysis. Therefore, the present study focused on patients with gastric cancer who underwent open gastrectomy.…”