Abstract
Background Totally laparoscopic total gastrectomy (TLTG) is still uncommon because of the difficult of esophago-jejunostomy technique laparoscopically which almost depends on surgeon. So far, the benefit as well as the reality of TLTG is under controversial. The aim of this study was to determine the useful extent of this procedure. Methods The literature on comparative studies of TLTG versus LATG up to now were extensively retrieved from database PubMed, Cochrane library, EMBASE. The operation times, blood loss, time to flatus, time to first oral intake, postoperative hospital stay, postoperative complications especially anastomosis leakage and anastomosis stenosis were analyzed. The statistical analysis was performed with STATs 13.0 software. Results Nine studies met the inclusion criteria for meta-analysis. Odds ratios (ORs) andweightedmeandifferences(WMDs) werecalculatedwith95%confidenceintervals (CIs)toevaluatetheeffectofTLTG.ComparetoLATG,TLTGexperiencedlessblood loss[weightedmeandifference(WMD)=-16.25ml,95%confidenceinterval(CI:- 29.25,-3.25,p=0.270)],smallerincisionlength(WMD=-2.74,95%CI:-4.60,- 89;p<0.01).Bowlrecoverywassimilarbetween2groupsandoveralllengthofhospital staywasequal(WMD=-0.28,95%CI:-0.76,0.20,p=0.761).Thecomplicationprofile was similar with equality in anastomosis leakage (WMD=0.83;95% CI:0.36,1.90;p=0.686)andstricture(WMD=0.98;95%CI:0.44,2.18;p=0.847)aswellas bleeding(WMD=1.55;95%CI:0.45,5.35;p=0.745).Noinferiorityinthenumberof retrievedlymphnode(WMD=1.41;95%CI:-0.45,3.28;p=0.296)aswellasproximal margin(WMD=0.11,95%CI:-0.11,0.33;p=0.346)wasnoticed. Conclusions TLTG is shown by this meta-analysis to be efficient and safe in the short term outcome. Future studies should evaluate oncological outcomes with adequate long-term follow-up, preferably in randomized trials. Legal entity responsible for the study National Cancer Center-Korea Funding National Cancer Center-Korea Disclosure All authors have declared no conflicts of interest.
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