Meta-Analysis
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World J Gastroenterol. Nov 14, 2014; 20(42): 15867-15878
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15867
Totally laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis of outcomes compared with open surgery
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, 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 Pan Y wrote the manuscript; Cai JQ, Xu XW and Wu D collected the literature and conducted the analysis of pooled data; Mou YP proofread and revised the manuscript; all authors approved the version to be published.
Supported by Zhejiang Key Subject of Medical Science Foundation, grant No.11-CX-21
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: April 10, 2014
Revised: May 9, 2014
Accepted: June 13, 2014
Published online: November 14, 2014
Abstract

AIM: To systematically review the surgical outcomes of totally laparoscopic gastrectomy (TLG) vs open gastrectomy (OG) for gastric cancer.

METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted. All original studies comparing TLG with OG were included for critical appraisal. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.

RESULTS: One RCT and 13 observational studies involving 1532 patients were included (721 TLG and 811 OG). TLG was associated with longer operation time [weighted mean difference (WMD) = 58.04 min, 95%CI: 37.77-78.32, P < 0.001], less blood loss [WMD = -167.57 min, 95%CI: -208.79-(-126.34), P < 0.001], shorter hospital stay [WMD = -3.75 d, 95%CI: -4.88-(-2.63), P < 0.001] and fewer postoperative complications (RR = 0.71, 95%CI: 0.58-0.86, P < 0.001). The number of harvested lymph nodes, surgical margin, mortality and cancer recurrence rate were similar between the two groups.

CONCLUSION: TLG may be a technically safe, feasible and favorable approach in terms of better cosmesis, less blood loss and faster recovery compared with OG.

Keywords: Gastric cancer, Gastrectomy, Intracorporeal anastomosis, Laparoscopy, Meta-analysis, Survival

Core tip: Laparoscopy-assisted gastrectomy for gastric cancer has rapidly become popular in the past decades due to its minimally invasive advantages over open gastrectomy (OG). However, totally laparoscopic gastrectomy (TLG) remains controversial in terms of safety and technical issues. This study evaluated the safety and efficacy of TLG compared with OG for gastric cancer by performing a systematic review and meta-analysis of the literature. The existing research shows that TLG is safe and feasible, and can achieve similar lymph node dissection effects to those of OG, and is characterized by advantages such as less pain, fewer postoperative complications, and rapid recovery, and is expected to achieve the same effect in oncological treatment as OG.