Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: A meta-analysis based on seven randomized controlled trials

Deng, Youcai; Zhang, Yan; Guo, Tiankang

doi:10.1016/j.suronc.2015.02.003

Cited by 95 publications

(79 citation statements)

References 26 publications

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“…During this period of time, a number of works have shown laparoscopic gastrectomy (LG) to be a feasible option in treating gastric cancer and level III studies provided the evidence that laparoscopic assisted distal gastrectomy (LADG) leads to better results in the short-term than conventionally performed open gastrectomy (OG) for early gastric cancer[2-5]. Due to the high incidence of gastric cancer and the extremely high levels of expertise achieved by Asian surgeons, LG is now a routine procedure for early gastric cancer in eastern states[6].…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis

Caruso¹,

Patriti²,

Roviello³

et al. 2017

WJCO

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AIMTo evaluate the potential effectiveness of robot-assisted gastrectomy (RAG) in comparison to open gastrectomy (OG) for gastric cancer patients.METHODSA comprehensive systematic literature search using PubMed, EMBASE, and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer. Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy. A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, morbidity, and hospital stay. Secondary among postoperative complications, wound infection, bleeding and anastomotic leakage were also analysed.RESULTSA total of 6 articles, 5 retrospective and 1 randomized controlled study, involving 6123 patients overall, with 689 (11.3%) cases submitted to RAG and 5434 (88.7%) to OG, satisfied the eligibility criteria and were included in the meta-analysis. RAG was associated with longer operation time than OG (weighted mean difference 72.20 min; P < 0.001), but with reduction in blood loss and shorter hospital stay (weighted mean difference -166.83 mL and -1.97 d respectively; P < 0.001). No differences were found with respect to overall postoperative complications (P = 0.65), wound infection (P = 0.35), bleeding (P = 0.65), and anastomotic leakage (P = 0.06). The postoperative mortality rates were similar between the two groups. With respect to oncological outcomes, no statistical differences among the number of harvested lymph nodes were found (weighted mean difference -1.12; P = 0.10).CONCLUSIONRAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.

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Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis

Caruso¹,

Patriti²,

Roviello³

et al. 2017

WJCO

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“…On the other hand, only few high quality reports investigating the oncological adequacy of laparoscopic minimally invasive techniques for advanced gastric cancer are available to date. Recently, some meta-analyses related to this have been published, but there have been contrasting outcomes, particularly regarding complications after total gastrectomy and the actual adequacy of D2 lymphadenectomy in patients affected by advanced-stage of gastric cancer[4,64,66-69]. Even though a complete LG and extended lymph nodes dissection has been demonstrated by several experts to be feasible laparoscopically[5,6,26,70], due to some intrinsic limiting drawbacks of the laparoscopic technique, important oncologic preoccupations have been raised.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, under the impulse of level III studies providing the evidence of the safety of laparoscopic assisted distal gastrectomy (LADG) for distal early-stage gastric cancer, several authors reported comparative studies with better short-term results in favor of this technique with respect to traditional open[2]. As a consequence laparoscopic gastrectomy (LG) has progressively spread worldwide, especially in the East, for the treatment of early gastric cancer[3,4]. On the other hand, the treatment of patients with advanced gastric cancer has always been considered difficult laparoscopically, thus techniques such as laparoscopic assisted total gastrectomy (LATG) and laparoscopic extended lymphadenectomy did not meet the same enthusiasm.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic gastrectomy for gastric cancer

Caruso¹,

Franceschini²,

Patriti³

et al. 2017

WJGE

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Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer.

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“…A metaanalysis of seven randomized controlled trials concluded that laparoscopic assisted gastrectomy significantly reduced blood loss and postoperative complications compared with open distal gastrectomy. 12 Obese patients undergoing surgery have been examined in several reports. The postoperative complication rate varies among studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

Choi

Kim

Yoo

et al. 2017

J Minim Invasive Surg

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Purpose:In this study, we explored the safety of laparoscopic gastrectomy in obese gastric cancer patients compared with conventional open gastrectomy based on early surgical outcomes. Methods:A total of 462 patients who underwent curative gastrectomy for early gastric adenocarcinoma from January 2000 to December 2014 were enrolled. Two obesity cohorts were defined according to a body mass index (BMI) of ≥25 kg/m 2 versus ≥30 kg/m 2 . Those cohorts were further divided into the laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) groups, and clinicopathologic characteristics were compared with early surgical results.Results: There were no significant differences in clinicopathologic characteristics between the LDG and ODG groups in the BMI ≥25 or BMI ≥30 cohorts. For the overall complication rate, fewer complications were observed in the LDG than ODG group in both cohorts. Among the overall complications, significant differences were observed in the minor complication rates (Clavien-Dindo I or II), but no significant difference was observed in the rate of Clavien-Dindo III or higher complications. For risk factor analysis of postoperative complications, open distal gastrectomy, age >60 years, and BMI ≥30 were independent risk factors for postoperative morbidity among all obese patients. Conclusion:LDG may be a better procedure to improve surgical outcomes in patients with obesity undergoing surgery for early gastric cancer in terms of less excessive blood loss, shorter operation time, and lower complication rates.

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Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: A meta-analysis based on seven randomized controlled trials

Cited by 95 publications

References 26 publications

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis

Robot-assisted laparoscopic gastrectomy for gastric cancer

Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

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