Meta-Analysis
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World J Gastroenterol. Nov 28, 2013; 19(44): 8114-8132
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8114
Laparoscopic vs open total gastrectomy for gastric cancer: A meta-analysis
Jun-Jie Xiong, Quentin M Nunes, Wei Huang, Chun-Lu Tan, Neng-Wen Ke, Si-Ming Xie, Xun Ran, Hao Zhang, Yong-Hua Chen, Xu-Bao Liu
Jun-Jie Xiong, Chun-Lu Tan, Neng-Wen Ke, Si-Ming Xie, Xun Ran, Hao Zhang, Yong-Hua Chen, Xu-Bao Liu, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Quentin M Nunes, Wei Huang, NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom
Author contributions: Xiong JJ and Nunes QM contributed equally to this work; Liu XB, Chen YH and Zhang H designed the research, and corrected and approved the manuscript; Xiong JJ, Nunes QM and Tan CL developed the literature search and carried out the statistical analyses of the studies; Huang W, Ke NW, Xie SM and Ran X performed data extraction; Xiong JJ, Nunes QM and Huang W wrote the manuscript; All authors read and approved the final manuscript.
Supported by UK/China Postgraduate Scholarships for Excellence, an NIHR Translational Research Fellowship and a Royal College of Surgeons of England-Ethicon Research Fellowship grant
Correspondence to: Xu-Bao Liu, MD, PhD, Professor, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Guo Xue Rd 37, Chengdu 610041, Sichuan Province, China. liuxb2011@126.com
Telephone: +86-28-85422474 Fax: +86-28-85422872
Received: June 19, 2013
Revised: September 10, 2013
Accepted: September 16, 2013
Published online: November 28, 2013
Abstract

AIM: To conduct a meta-analysis comparing laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) for the treatment of gastric cancer.

METHODS: Major databases such as Medline (PubMed), Embase, Academic Search Premier (EBSCO), Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013. Evaluated endpoints were operative, postoperative and oncological outcomes. Operative outcomes included operative time and intraoperative blood loss. Postoperative recovery included time to first flatus, time to first oral intake, hospital stay and analgesics use. Postoperative complications comprised morbidity, anastomotic leakage, anastomotic stenosis, ileus, bleeding, abdominal abscess, wound problems and mortality. Oncological outcomes included positive resection margins, number of retrieved lymph nodes, and proximal and distal resection margins. The pooled effect was calculated using either a fixed effects or a random effects model.

RESULTS: Fifteen non-randomized comparative studies with 2022 patients were included (LTG - 811, OTG - 1211). Both groups had similar short-term oncological outcomes, analgesic use (WMD -0.09; 95%CI: -2.39-2.20; P = 0.94) and mortality (OR = 0.74; 95%CI: 0.24-2.31; P = 0.61). However, LTG was associated with a lower intraoperative blood loss (WMD -201.19 mL; 95%CI: -296.50--105.87 mL; P < 0.0001) and overall complication rate (OR = 0.73; 95%CI: 0.57-0.92; P = 0.009); fewer wound-related complications (OR = 0.39; 95%CI: 0.21-0.72; P = 0.002); a quicker recovery of gastrointestinal motility with shorter time to first flatus (WMD -0.82; 95%CI: -1.18--0.45; P < 0.0001) and oral intake (WMD -1.30; 95%CI: -1.84--0.75; P < 0.00001); and a shorter hospital stay (WMD -3.55; 95%CI: -5.13--1.96; P < 0.0001), albeit with a longer operation time (WMD 48.25 min; 95%CI: 31.15-65.35; P < 0.00001), as compared with OTG.

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

Keywords: Gastric cancer, Laparoscopic total gastrectomy, Laparoscopic assisted total gastrectomy, Open total gastrectomy, Meta-analysis

Core tip: Currently, surgical resection is the mainstay treatment for gastric cancer. With technical advances and improved instrumentation, laparoscopic total gastrectomy (LTG) is being used increasingly to treat this malignant disease. However, compared with conventional open total gastrectomy (OTG), the safety and technical feasibility of LTG have not been adequately evaluated. This study clarified that, compared with OTG, LTG has similar short-term oncological outcomes, analgesic use and mortality. Furthermore, LTG was associated with lower intraoperative blood loss and overall complication rate, fewer wound-related complications, quicker recovery of gastrointestinal motility and a shorter hospital stay, albeit with a longer operation time.