Laparoscopic versus open gastrectomy for early distal gastric cancer: a meta-analysis

Liang, Yi-chao; Li, Guoxin; Chen, Pingyan; Yu, Jiang; Zhang, Ce

doi:10.1111/j.1445-2197.2010.05599.x

Cited by 46 publications

(38 citation statements)

References 42 publications

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“…Significant reductions in the use of analgesics and narcotics, more rapid recovery of intestinal movement, and faster return to normal diet in LAG group together contribute to a reduction in hospital stay, although local hospital policies are different worldwide. These results concur with previous published analyses (Hosono et al, 2006;Liang et al, 2011;Ding et al, 2012;Vinuela et al, 2012), making the meta-analysis of short-term outcomes unnecessary. This study (815 patients) focused on the surgical safety and oncologic results for LAG with extended lymphadenectomy of seven studies comparing laparoscopic with open surgery for mainly AGC; and confirmed that LAG for AGC achieved equivalent morbidity rates.…”

Section: Discussionsupporting

confidence: 92%

“…7, 8a, and 9) lymphadenectomy in older and in high-risk patients. Some reports argue that conventional open surgery is superior to laparoscopic surgery (Miura et al, 2004;Liang et al, 2011) in extraperigastric lymphadenectomy, especially the second tier nodes, station Nos. 7, 8, 9, and 11, along the branches of celiac artery.…”

Section: Discussionmentioning

confidence: 99%

“…There are few reports related to the efficacy of LAG in the management for AGC. Regarding the inclusion criteria used to select studies, the recent reports (Hosono et al, 2006;Liang et al, 2011;Ding et al, 2012;Vinuela et al, 2012) included patients with EGC. AGC has rarely been evaluated rigorously in a study.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Liu

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC). Methods: Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model. Results: Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI −2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05). Conclusions: LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Liu

et al. 2013

J. Zhejiang Univ. Sci. B

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“…Usefulness of laparoscopic approach with regard to iSSIs has been reported not only for gastric cancer surgery [12] , but also for some other abdominal surgeries [13][14][15] . Laparoscopic gastrectomy has been reported to be superior to open gastrectomy in terms of short-term outcome of early stage cancer surgery [16,17] . As for long-term survival outcomes, although the result of some randomized controlled trials must be waited for [18,19] , laparoscopic approach has been likely to be noninferior to open surgery [20] .…”

Section: Discussionmentioning

confidence: 99%

A Risk Model for Surgical Site Infection in the Gastric Cancer Surgery Using Data of 790 Patients

Ushiku¹,

Hosoda²,

Yamashita³

et al. 2015

Dig Surg

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Background: Understanding risk factors of surgical site infections (SSIs) in gastrectomy is important to provide the best treatment for the patients with gastric cancer. Methods: This is a retrospective observational study using the medical records of 790 patients with gastrectomy from 2005 through 2009. SSIs were classified into incisional SSIs (iSSIs) and organ/space SSIs (o/sSSIs). Results: iSSIs and o/sSSIs were detected in 41 (5.2%) patients and 68 (8.6%) patients, respectively. Open surgery was the only independent risk factor (p = 0.028) for iSSIs, while open surgery (p = 0.004), concurrent splenectomy (p < 0.001), operative time ≥220 min (p = 0.009), preoperative body mass index ≥20.8 kg/m² (p = 0.004) and male gender (p = 0.028) were the independent risk factors for o/sSSIs. We created a risk model for o/sSSIs using these independent risk factors. The C-index model discrimination was 0.84 (p < 0.001), and the calibration of the models demonstrated a linear correlation between the predicted and observed probability. Conclusion: We reported the risk factors of SSIs for gastrectomy. The risk model developed in this study for o/sSSIs pertaining to gastric cancer surgery would contribute to provide guidance for the development of best practices.

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“…Nevertheless, two very comprehensive meta-analyses concluded that LG is better or comparable to open surgery with regards to early and long-term outcomes, although at the price of a longer duration of surgery. 51,52 One rigorous RCT (KLASS trial) confirmed equivalent early outcomes of laparoscopic and open approach to gastrectomy for cancer. 53 RS for gastric cancer has been demonstrated to overcome intrinsic limitations of conventional laparoscopic surgery, thanks to the wristed instruments that allow seven degrees of freedom, tremor filtering, three-dimensional vision, and a steady image, thus minimizing blood losses and surgical trauma and improving the surgeon's dexterity when fine manipulation is required.…”

mentioning

confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

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Abstract:The rapid diffusion of new technologies in surgery, together with high expectations of both patients and the mass media, has led to many gastrointestinal procedures being approached using robots. Robotic technology seems to resolve many of the drawbacks of laparoscopic advanced procedures, such as anastomotic reconstructions, accurate lymphadenectomy, and vascular sutures. In addition, a deeper tridimensional steady vision with excellent high definition, the EndoWrist technology offering seven degrees of freedom, tremor filtration, scaled motion, optimal working ergonomics, and avoidance of the 'fulcrum effect', are the main strengths of the da Vinci ® system. The use of near-infrared technology and the possibility of tutoring through a double-console will most likely add many more advantages of this technology over laparoscopy alone. However, none of the gastrointestinal robotic interventions has reached a level of evidence-based efficacy that enables it to be routinely applied. The main limitations of robotic gastrointestinal procedures are represented by the learning curve, the higher costs of robotic surgery compared to traditional and laparoscopic surgery, and the longer operation times, including setup and organizational troubles. Moreover, while the limits of robotics for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies, and long-term follow-up is still lacking. On the other hand, a word of caution should be presented on the adoption of robotics in too many surgical units without the correct and formal technical background and third-party control to guarantee the best outcomes for patients at minimum risk. Therefore, the robotic treatment of gastrointestinal diseases requires a thorough analysis of the published evidence, in order to determine the correct indications and patient selection. This review aims to examine the evidence for the use of robotic surgery in both malignancies and benign disease arising from the gastrointestinal area. Future developments in robotics and ongoing areas of research are also analyzed.

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Laparoscopic versus open gastrectomy for early distal gastric cancer: a meta-analysis

Abstract: The results of this meta-analysis suggest that LAG for early distal cancer is a feasible and safe alternative to COG, with better short-term outcomes.

Cited by 46 publications

References 42 publications

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

A Risk Model for Surgical Site Infection in the Gastric Cancer Surgery Using Data of 790 Patients

Gastrointestinal robotic surgery: challenges and developments

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