Published online Dec 28, 2020. doi: 10.13105/wjma.v8.i6.472
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
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.
To assess the safety and practicability of HALG by comparing the short-term outcomes of HALG and LAG.
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.
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).
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.
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.