Laparoscopic<i>vs</i>open total gastrectomy for gastric cancer: A meta-analysis

Xiong, Junjie; Nunes, Quentin; Huang, Wei; Tan, Chunlu; Ke, Nengwen; Xie, Sheng‐Xue; Ran, Xun; Zhang, Hao; Chen, Yonghua; Liu, Xu-Bao

doi:10.3748/wjg.v19.i44.8114

Cited by 72 publications

(67 citation statements)

References 40 publications

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“…One must be aware of the inevitable selection bias in such a retrospective case series. The indications for laparoscopic gastrectomy might have differed among hospitals, and more advanced cases most [29,30] and laparoscopic total gastrectomy [31]. In terms of the postoperative complication rate, four studies of five reported a 6.5-20 % risk reduction in laparoscopic approach compared to the open approach.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic gastrectomy for remnant gastric cancer: a comprehensive review and case series

et al. 2014

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Background Remnant gastric cancer is increasing with the earlier detection of gastric cancer and improved medical care. Laparoscopic gastrectomy for remnant gastric cancer has been reported sporadically in association with the increased use of minimally invasive techniques. However, because of the rarity of remnant gastric cancer, the number of cases reported per study has been small. We therefore reviewed all published English-language reports, including our experience, to better characterize the technical aspects of currently used procedures. Methods Ten patients who underwent laparoscopic gastrectomy for remnant cancer between August 2005 and March 2014 were retrospectively studied. A comprehensive literature search was performed using the PubMed database to identify English-language studies on laparoscopic gastrectomy for remnant gastric cancer that were published before May 2014. Results There was no conversion to open surgery. The mean operating time was 325 min, and mean intraoperative blood loss was 55 g. The mean number of retrieved lymph nodes was 22, and mean postoperative hospital stay was 13 days. There was only one minor wound infection (overall morbidity rate, 10 %). From the literature review, all comparative studies revealed that laparoscopic gastrectomy for remnant gastric cancer required a longer operating time, and most studies reported less intraoperative blood loss, an equivalent number of harvested lymph nodes, and a shorter postoperative stay as compared with open surgery. Conclusion Proficiency in advanced laparoscopic surgical techniques, such as proper adhesiolysis and stable laparoscopic anastomosis, will allow laparoscopic gastrectomy for remnant gastric cancer to be performed with satisfactory short-term results. This minimally invasive approach can be one treatment option for remnant gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic gastrectomy for remnant gastric cancer: a comprehensive review and case series

et al. 2014

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“…The benefits of minimally invasive surgical methods are proven and well published [6,[10][11][12][13][14][15][16]. With advantages such as decreased postoperative pain and shorter length of hospital stay, minimally invasive techniques are heralded as a significant development in the progress of general surgery.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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Background Minimally invasive surgical techniques are increasingly being implemented in oncologic care. This study assesses the impact of minimally invasive surgery on oncologic and perioperative outcomes in the management of gastric cancer in the USA. Methods From the American College of Surgeons and American Cancer Society National Cancer Data Base, we identified 6427 patients who underwent gastrectomy for cancer from 2010 to 2012. Treatment groups were categorized with an intention-to-treat paradigm as robotic, laparoscopic, and open surgery. Univariate and multivariate analyses were performed to estimate the impact of the surgical approach on oncologic and perioperative outcomes. Results Of patients undergoing definitive surgical intervention, 3.5 % (n = 223) underwent robotic gastrectomy, 23.1 % (n = 1487) underwent laparoscopic gastrectomy, and 73.4 % (n = 4717) underwent open surgery. Minimally invasive gastrectomy was more frequently performed on white (P = 0.018), privately insured patients (P = 0.049) treated at academic centers (P \ 0.0001) in the eastern USA (P \ 0.0001). After demographics, comorbidities, and tumor-related factors had been controlled for, patients who underwent laparoscopic gastrectomy had the postoperative length of stay decreased by 1.08 days (P \ 0.0001) and greater odds of having at least 15 lymph nodes resected (odds ratio 1.16, P = 0.023). Use of robotic surgery did not have a statistically significant effect on the postoperative length of stay relative to open surgery (P = 0.222) but the patients so treated had greater odds of having at least 15 lymph nodes resected (odds ratio 1.51, P = 0.005). There were no differences in R0 resection rates or perioperative mortality on the basis of the surgical approach alone. Conclusions These findings suggest that use of minimally invasive surgery for gastric cancer in the USA is impacting the adequacy of oncologic resection but is not yet having a clinically significant impact on perioperative outcomes relative to a conventional open approach.

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“…[8][9][10][11][12][13] However, there are many reconstruction methods of E-J stomy for LTG. Generally, the E-J stomy methods can be divided into two main types depending on whether a circular stapling, [14][15][16][17][18][19][20][21] or linear stapling 22-29 approach was used.…”

Section: Reconstruction Methodsmentioning

confidence: 99%

“…[9][10][11][12][13] LTG and OTG were similar in terms of the number of harvested lymph nodes (LNs), resection margin, hospital mortality, and long-term outcomes. The only disadvantage of LTG was a longer operative time.…”

Section: Comparison Between Ltg and Open Total Gastrectomy (Otg)mentioning

confidence: 99%

“…30,31 The experience of the surgeon, the level of cooperation of the surgical team, and advances in laparoscopic instruments help to reduce the morbidity rate of LTG with splenectomy. Because LTG was associated with lower morbidity than OTG in two updated meta-analyses, 11,12 the JCOG 0110 OTG trials do not allow conclusions to be made on the safety LTG. More studies comparing LTG with and without splenectomy are therefore necessary.…”

Section: Ltg Without Splenectomy Versus Ltg With Splenectomy For Advamentioning

confidence: 99%

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Laparoscopic Total Gastrectomy for Gastric Cancer

Jung

Kim

2015

J Minim Invasive Surg

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Laparoscopic total gastrectomy (LTG) has been more widely performed in the last decade because of improvements in the techniques and safety of laparoscopic distal gastrectomy. However, due to its technical difficulty, there are still concerns regarding the safety of LTG. Meta-analyses have shown that LTG is technically feasible, safe, and may offer advantages over open total gastrectomy for treatment of gastric cancer. Various methods of performing esophagojejunostomy have been developed in an effort to decrease the rate of anastomosis-related complications, and have ultimately improved the safety and acceptance of LTG. However, there is still a lack of level-one evidence in support of LTG. Conduct of large-scale, randomized clinical trials will be needed in order to verify the safety and efficacy of LTG. Therefore, we reviewed the current status and some of the controversies surrounding LTG.

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Laparoscopicvsopen total gastrectomy for gastric cancer: A meta-analysis

Abstract: LTG is safe and effective, and may offer some advantages over OTG in the treatment of gastric cancer.

Cited by 72 publications

References 40 publications

Laparoscopic gastrectomy for remnant gastric cancer: a comprehensive review and case series

Laparoscopic gastrectomy for remnant gastric cancer: a comprehensive review and case series

Minimally invasive surgery for gastric cancer: the American experience

Laparoscopic Total Gastrectomy for Gastric Cancer

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