Laparoscopic versus open gastrectomy for early distal gastric cancer: a meta-analysis

Abstract

We performed a meta-analysis in an attempt to answer whether short-term outcomes and lymph nodes harvested after laparoscopy-assisted gastrectomy (LAG) are comparable to those reported after conventional open gastrectomy (COG). Prospective randomized clinical trials were eligible if they included patients with distal gastric cancer treated by LAG versus COG. End points were operating time, intra-operative blood loss, size of wound, overall post-operative complications, time to first flatus, time to start oral intake, hospital stay and lymph nodes harvested. Six trials including 668 patients were included. For four of the 13 end points, the summary point estimates favoured LAG over COG; there was a significant reduction in intra-operative blood loss (weighted mean difference (WMD) −115.60, 95% confidence interval (CI) −159.16 to −72.04, P < 0.00001), size of wound (WMD −5.27, 95% CI −8.94 to −1.60, P= 0.005), overall post-operative complications (odds ratio 0.55, 95% CI 0.35 to 0.85, P = 0.008) and hospital stay (WMD −2.65, 95% CI −4.97 to −0.32, P= 0.03) for LAG. However, the combined results of the individual trials show significant longer operating time (WMD 112.98, 95% CI 60.32 to 165.64, P < 0.0001) and significant reduction in lymph nodes harvested (WMD −4.79, 95% CI −6.79 to −2.79, P < 0.00001) in the LAG group. There was no significant difference between the two groups in time to first flatus, time to start oral intake, wound infection, intra-abdominal fluid collection and abscess, anastomotic stenosis and leakage and pulmonary complications. The results of this meta-analysis suggest that LAG for early distal cancer is a feasible and safe alternative to COG, with better short-term outcomes.