Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 19; no. 3; pp. 939 - 950
• Main Authors: Quan, Yingjun, Huang, Ao, Ye, Min, Xu, Ming, Zhuang, Biao, Zhang, Peng, Yu, Bo, Min, Zhijun
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.07.2016; Springer Nature B.V
• Subjects: Abdominal Surgery; Cancer Research; Gastrectomy - methods; Gastric cancer; Gastroenterology; Humans; Laparoscopy - methods; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Original Article; Postoperative Complications; Prognosis; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgical Oncology; Laparoscopic gastrectomy; Open gastrectomy; Advanced gastric cancer; Meta-analysis
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-015-0516-x

Background Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. Methods Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. Results Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, −3.63, 95 % CI, −4.66 to −2.60; P  < 0.01), less blood loss (WMD, −161.37, 95 % CI, −192.55 to −130.18; P  < 0.01), faster bowel recovery (WMD, −0.78, 95 % CI, −1.05 to −0.50; P  < 0.01), and earlier ambulation (WMD, −0.95, 95 % CI, −1.47 to −0.44; P  < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, −0.49, 95 % CI, −1.78 to 0.81; P  = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P  < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. Conclusions For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.