Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien–Dindo classification

Kim, Dong Jin; Lee, Jun Hyun; Kim, Wook

doi:10.1007/s00464-014-4053-1

Cited by 50 publications

(39 citation statements)

References 27 publications

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“…There was significant heterogeneity among studies ( p = 0.13; I 2 = 51%), so we used a random-effect model here(Fig 2). Five studies [6,7,13,14,17] reported harvested lymph nodes, meta-analysis confirmed that TG procedure could retrieve more lymph nodes than DG (MD = 4.33, 95% CI = 2.34–6.31, p <0.0001) (Fig 2). …”

Section: Resultsmentioning

confidence: 79%

“…The flow diagram of reviews shows the detailed process of selection (Fig 1). Finally, 11 studies [6,7,9–17] involving 5447 patients (2418 by TG vs 3029 by DG) were included for our analysis which included Laparoscopy-assisted and open gastrectomy for gastric cancer (Table 3). The baseline characteristics between both groups were shown in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…Three articles [6,13,17] reported blood loss and four studies [6,7,13,17]reported operation time. Meta-analyses showed that DG took obviously shorter operative time than TG procedure (MD = 50.73, 95% CI: 12.75–88.72, p = 0.009), heterogeneity was observed ( p <0.00001; I 2 = 96%), so we used a random-effect model for this analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Data regarding hospital stay were provided in four studies [6,7,12,17] involving 2559 patients, meta-analysis showed that there was no significant difference in the length of hospital stay between TG and DG group (MD = 0.76, 95% CI:-0.26–1.79, p = 0.15) (Fig 3). …”

Section: Resultsmentioning

confidence: 99%

“…However, the distal subtotal gastrectomy and total gastrectomy for centuries, there has been controversy about the choice of the best surgical procedure for the distal half of gastric cancer which is usually resection by the distal subtotal gastrectomy in china[5]. Although total gastrectomy can maximumly reduce gastric remnant cancer[6], it leads to the postoperative limited diet, dysphagia, dry mouth, and reflux symptoms which will affect the patient's quality of life [7]. Whether distal subtotal gastrectomy and total gastrectomy is the same in perioperative period, complications and long-term survival rate or not, different studies have different results.…”

Section: Introductionmentioning

confidence: 99%

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Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Zhang²,

Wang

et al. 2016

PLoS ONE

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Background/AimsTotal gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer.MethodologyA search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis.ResultsTen retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006).ConclusionBased on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed.

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