Comparison of Safety and Efficacy of Open, Laparoscopic-Assisted, Totally Laparoscopic, and Robotic Gastrectomy for Gastric Cancer:A Network Meta-Analysis

Background: Several techniques are used for surgical treatment of gastric cancer (GC), but the efficacy and safety of these approaches have not been compared. Methods: We systematically searched articles of randomized controlled trials (RCTs) through PubMed, Embase, Cochrane Library and ISI-Web of Science databases. The primary outcome was safety using overall morbidity as the main indicator of safety. The secondary outcome was efficacy using the number of harvested lymph nodes (HLNs) as an indicator of efficacy. Multiple surgical treatment comparisons based on Bayesian network integrated the safety and efficacy of all included approaches. The ranking probability was appraised by the probability of the surgical approaches. Results: The 19 eligible RCTs with 4309 patients were included in the network meta-analysis (NMA). There were no differences in overall morbidity between open gastrectomy (OG) and laparoscopic-assisted gastrectomy (LAG) [odds ratio (OR) 1.09, 95% credible interval (Crl): 0.86-1.64], OG and robotic gastrectomy (RG) (OR 1.16, 95% Crl: 0.43-3.07), LAG and totally laparoscopic gastrectomy (TLG) (OR 2.85, 95% Crl: 0.67-12.52), RG and LAG (OR 0.96, 95% Crl: 0.36-2.93), TLG and OG (OR 0.32, 95% Crl: 0.07-1.38) and TLG and RG (OR 0.35, 95% Crl: 0.06-2.01). There were also no differences in the number of HLNs between OG and LAG [weighted mean difference (WMD) 0.91, 95% Crl: -0.24-2.43)], OG and RG (WMD 1.55, 95% Crl: -2.58- 5.51), LAG and TLG (WMD -0.90, 95% Crl: -6.82-5.18), RG and LAG (WMD -0.68, 95% Crl: -4.63- 3.91), TLG and OG (WMD -0.01, 95% Crl: -6.41-5.90) and TLG and RG (WMD 1.56, 95% Crl: -6.01-8.59). From the results of the rank probabilities of the four surgical treatments, TLG had the highest probability of being the safest and the most effective surgical approaches. Conclusions: The four surgical treatments of GC have similar safety and efficacy. TLG had the best chance of becoming the safest and most effective treatment.

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