Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 28, 2020; 8(6): 472-481
Published online Dec 28, 2020. doi: 10.13105/wjma.v8.i6.472
Comparison of hand-assisted laparoscopic radical gastrectomy and laparoscopic-assisted radical gastrectomy: A systematic review and meta-analysis
Wei Gan, Zhen-Yu Chen, Li-Ye Liu, Gui-Bing Chen, Jun Zhou, Ya-Ning Song, Yong-Kuan Cao
Wei Gan, Zhen-Yu Chen, Gui-Bing Chen, Jun Zhou, Ya-Ning Song, Yong-Kuan Cao, Department of Gastrointestinal Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Li-Ye Liu, Department of General Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Author contributions: Gan W, Chen ZY, Liu LY, and Chen GB designed the research study; Gan W, Chen ZY, and Liu LY performed the research; Zhou J and Song YN contributed analytic tools; Gan W, Chen GB, and Cao YK analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported by Science and Technology Program of Sichuan Province, China, No. 2017JY0346.
Conflict-of-interest statement: The authors deny any conflict of interest related to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Kuan Cao, PhD, Chief Physician, Department of Gastrointestinal Surgery, The General Hospital of Western Theater Command, No. 270 Rongdu Avenue, Chengdu 610083, Sichuan Province, China. yongkuancao@163.com
Received: October 23, 2020
Peer-review started: October 23, 2020
First decision: November 20, 2020
Revised: November 29, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: December 28, 2020
Abstract
BACKGROUND

Gastrectomy is the optimal treatment for gastric cancer. Laparoscopic-assisted gastrectomy (LAG) has been extensively employed, while hand-assisted laparoscopic gastrectomy (HALG), which is similar to LAG, remains controversial. Although HALG is popular in China, some surgeons do not accept it as a minimal-access technique. 

AIM

To assess the safety and practicability of HALG by comparing the short-term outcomes of HALG and LAG.

METHODS

The electronic databases of EMBASE, PubMed, China National Knowledge Infrastructure, and Cochrane Library were thoroughly searched, and randomized controlled trials (RCTs) comparing HALG and LAG were included. The study results, including surgery time, blood loss, retrieved lymphatic nodes, incision length, time to first flatus, hospitalization duration, and all postsurgical complications, were compared between the two groups.

RESULTS

Five RCTs, which included 302 cases with HALG and 298 cases with LAG, were considered eligible for inclusion. Meta-analysis showed that HALG significantly reduced surgery time (P < 0.01), hospital duration (P < 0.01), and overall postsurgical complications (P < 0.01). Additionally, HALG significantly increased the number of retrieved lymphatic nodes (P = 0.01) and incision length (P < 0.01) compared with LAG. The blood loss and time to first flatus were similar between the two groups (P > 0.05).

CONCLUSION

Compared with LAG, HALG is a simpler and safer technique. Additionally, HALG should be used as a minimal-access technique, especially in technologically undeveloped areas.

Keywords: Gastric cancer, Hand-assisted laparoscopy, Gastrectomy, Laparoscopic-assisted gastrectomy, Meta-analysis, Systematic review

Core Tip: No consensus is available in the literature about which technique is more beneficial to the patients between hand-assisted laparoscopic gastrectomy (HALG) and laparoscopic-assisted gastrectomy (LAG). This is the first systematic review and meta-analysis comparing HALG and LAG. We compared these two techniques in terms of estimated surgery time, blood loss, retrieved lymphatic nodes, incision length, time to first flatus, hospitalization duration, and all postsurgical complications from selected randomized controlled trials. Compared with LAG, HALG is a simpler and safer technique.