Meta-Analysis
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World J Gastroenterol. Aug 28, 2013; 19(32): 5365-5376
Published online Aug 28, 2013. doi: 10.3748/wjg.v19.i32.5365
Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer
Ke Chen, Xiao-Wu Xu, Ren-Chao Zhang, Yu Pan, Di Wu, Yi-Ping Mou
Ke Chen, Xiao-Wu Xu, Ren-Chao Zhang, Yu Pan, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Chen K and Xu XW wrote the manuscript; Zhang RC, Pan Y and Wu D collected literatures and conducted the analysis of pooled data; Mou YP proofread and revised the manuscript; all authors have approved the version to be published.
Supported by The key project grant from the Science and Technology Department of Zhejiang Province, China, No. 2011C3036-2
Correspondence to: Yi-Ping Mou, MD, PhD, Professor, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. mouyiping2002@163.com
Telephone: +86-571-86006445 Fax: +86-571-86044817
Received: March 29, 2013
Revised: May 23, 2013
Accepted: July 9, 2013
Published online: August 28, 2013
Abstract

AIM: To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) and open total gastrectomy (OTG) for gastric cancer.

METHODS: A comprehensive search of PubMed, Cochrane Library, Web of Science and BIOSIS Previews was performed to identify studies that compared LATG and OTG. The following factors were checked: operating time, blood loss, harvested lymph nodes, flatus time, hospital stay, mortality and morbidity. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.

RESULTS: Nine studies with 1221 participants were included (436 LATG and 785 OTG). Compared to OTG, LATG involved a longer operating time [weighted mean difference (WMD) = 57.68 min, 95%CI: 30.48-84.88; P < 0.001]; less blood loss [standard mean difference (SMD) = -1.71; 95%CI: -2.48 - -0.49; P < 0.001]; earlier time to flatus (WMD= -0.76 d; 95%CI: -1.22 - -0.30; P < 0.001); shorter hospital stay (WMD = -2.67 d; 95%CI: -3.96 - -1.38, P < 0.001); and a decrease in medical complications (RR = 0.41, 95%CI: 0.19-0.90, P = 0.03). The number of harvested lymph nodes, mortality, surgical complications, cancer recurrence rate and long-term survival rate of patients undergoing LATG were similar to those in patients undergoing OTG.

CONCLUSION: Despite a longer operation, LATG can be performed safely in experienced surgical centers with a shorter hospital stay and fewer complications than open surgery.

Keywords: Laparoscopy, Total gastrectomy, Gastric cancer, Complications, Meta-analysis

Core tip: This study evaluated the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) and open total gastrectomy (OTG) for gastric cancer through systematic review and meta-analysis. The existing research shows that LATG is safe and feasible, which can achieve similar lymph node dissection effects as OTG, characterized by such advantages as less pain, fewer postoperative complications, and rapid recovery, and which is expected to achieve the same effect in oncological treatment as OTG.