Abstract
Background. Some meta-analyses of case-controlled studies (CCSs) have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG) had some short-term advantages over open total gastrectomy (OTG). However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients' status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients) from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29–0.85, P = 0.01, I 2 = 0%, and OR 0.46, 95% CI 0.17–0.52, P < 0.0001, I 2 = 0%). However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96–2.16, P = 0.08, I 2 = 0%). Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.
Highlights
Laparoscopic distal gastrectomy (LDG) is an established minimally invasive procedure for the treatment of gastric cancer, especially in Eastern Asia
Wound complications were reported in 89 of a total of 2,430 patients in 13 studies, and the incidence of wound complications was significantly lower in laparoscopy-assisted total gastrectomy (LTG) than that in open total gastrectomy (OTG) (Figure 2(c))
LTG was associated with a significantly lower incidence of wound complications than was OTG in this meta-analysis of case-controlled studies (CCSs), in which age, gender, physical status, tumor stage, extent of lymph-node dissection, and reconstruction procedure were matched between the two groups
Summary
Laparoscopic (laparoscopy-assisted) distal gastrectomy (LDG) is an established minimally invasive procedure for the treatment of gastric cancer, especially in Eastern Asia. One of the reasons is that advanced techniques are required to perform lymph-node dissection along the splenic artery as well as reconstruction by esophagojejunostomy Another reason is that the incidence of gastric cancer is lower in the upper portion of the stomach than in the middle or lower portions, especially in Eastern Asia. Some meta-analyses of case-controlled studies (CCSs) have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG) had some short-term advantages over open total gastrectomy (OTG). Studies matched for patients’ status, tumor stage, and the extents of lymph-node dissection were included Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; some concern remains about anastomotic problems associated with LTG
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