Totally laparoscopic gastrectomy for gastric cancer: Meta-analysis of short-term outcomes

Abstract Introduction: We present a review of the literature, together with a meta-analysis of short-term outcomes of totally laparoscopic gastrectomy (TLG) compared with open gastrectomy (OG). Material & methods: We carried out a search in the Pubmed and Cochrane databases from September 2003 to May 2009. Controlled studies on early outcomes were included, both prospective and retrospective, randomized and non-randomized. Results: We found nine eligible studies, one of which was a randomized controlled trial (RCT), while eight were series of patients (three consecutive). The study group consisted of 1,492 patients, 828 of whom had been treated with TLG and 664 treated with OG. TLG for gastric cancer shows a 32.5% (p < 0.001) longer operative time than OG, whereas TLG demonstrated a 44% (p < 0.001) reduction in blood loss, a 34% (p < 0.001) reduction time to first flatus and a 33.7% reduced (p < 0.001) hospital stay. No notable differences were registered regarding morbidity and mortality rates, and no significant difference was observed between the two groups regarding the extent of the lymphadenectomy. Conclusions: Despite a longer operative time for TLG, with a gastrointestinal recovery rate faster than the OG one for gastric cancer results, no notable differences were recorded between the two techniques for the morbidity and mortality rates and in the spread of the lymphadenectomy.

[1]  P. Fayers,et al.  Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial , 1996, The Lancet.

[2]  H. Hur,et al.  Is Totally Laparoscopic Gastrectomy Less Invasive Than Laparoscopy-assisted Gastrectomy?: Prospective, Multicenter Study , 2008, Journal of Gastrointestinal Surgery.

[3]  J. Young,et al.  META‐ANALYSIS OF NON‐RANDOMIZED COMPARATIVE STUDIES OF THE SHORT‐TERM OUTCOMES OF LAPAROSCOPIC RESECTION FOR COLORECTAL CANCER , 2007, ANZ journal of surgery.

[4]  F. Sansonna,et al.  Total and subtotal laparoscopic gastrectomy for adenocarcinoma , 2005, Surgical Endoscopy.

[5]  M. Gonen,et al.  Laparoscopic Versus Open Subtotal Gastrectomy for Adenocarcinoma: A Case–Control Study , 2009, Annals of Surgical Oncology.

[6]  K. Song,et al.  Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience , 2008, Surgical Endoscopy.

[7]  K. Zucker,et al.  Laparoscopic cholecystectomy: a review of 12,397 patients. , 1992, Surgical laparoscopy & endoscopy.

[8]  M. Ochiai,et al.  Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. , 2002, American journal of surgery.

[9]  Jung-Chieh Chen,et al.  Totally Laparoscopic Radical BII Gastrectomy for the Treatment of Gastric Cancer: A Comparison With Open Surgery , 2008, Surgical laparoscopy, endoscopy & percutaneous techniques.

[10]  H. Osugi,et al.  Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases , 2008, Surgical Endoscopy.

[11]  M. Gagner,et al.  Laparoscopic vs open gastrectomy. A retrospective review. , 2001, Surgical endoscopy.

[12]  Y. Kodera,et al.  Laparoscopy‐assisted distal gastrectomy with systemic lymph node dissection: A phase II study following the learning curve , 2005, Journal of surgical oncology.

[13]  I. Olkin,et al.  Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement , 1999, The Lancet.

[14]  A. Sarela.  Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins , 2008, Surgical Endoscopy.

[15]  M. Tanaka,et al.  Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer , 2005, Surgical Endoscopy And Other Interventional Techniques.

[16]  A. Dhar,et al.  National Institute for Health and Clinical Excellence , 2005 .

[17]  Kazuhiro Yasuda,et al.  Laparoscopic gastrectomy with lymph node dissection for gastric cancer , 2006, Gastric Cancer.

[18]  S. Kitano,et al.  Laparoscopic-assisted proximal gastrectomy for early gastric carcinomas , 2006, Surgery Today.

[19]  S. Kitano,et al.  Indication for and outcome of laparoscopy‐assisted Billroth I gastrectomy , 1999, The British journal of surgery.

[20]  Cristiano G S Huscher,et al.  Laparoscopic Versus Open Subtotal Gastrectomy for Distal Gastric Cancer: Five-Year Results of a Randomized Prospective Trial , 2005, Annals of surgery.

[21]  Xin-Zu Chen,et al.  Short-term Evaluation of Laparoscopy-assisted Distal Gastrectomy for Predictive Early Gastric Cancer: A Meta-analysis of Randomized Controlled Trials , 2009, Surgical laparoscopy, endoscopy & percutaneous techniques.

[22]  J. Périssat,et al.  Laparoscopic and open gastric resections for malignant lesions: A prospective comparative study , 2005, Surgical Endoscopy And Other Interventional Techniques.

[23]  Min-Chan Kim,et al.  Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. , 2005, World journal of gastroenterology.

[24]  Sang-Yong Son,et al.  Minimally invasive surgery in gastric cancer. , 2014, World journal of gastroenterology.

[25]  S. Kitano,et al.  A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. , 2002, Surgery.

[26]  N. Nguyen,et al.  Comparison of laparoscopic and open gastrectomy for gastric cancer. , 2006, American journal of surgery.

[27]  H. Ortiz,et al.  Surgical treatment of recurrent gastric cancer , 2008, Gastric Cancer.

[28]  Japanese Gastric Cancer Association.  Japanese Classification of Gastric Carcinoma – 2nd English Edition – , 1998, Gastric Cancer.

[29]  J. Hermans,et al.  Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients , 1995, The Lancet.

[30]  G. Dionigi,et al.  Laparoscopic gastrectomy for gastric cancer : Current evidences , 2014 .

[31]  C. Park,et al.  The Early Experience with a Totally Laparoscopic Distal Gastrectomy , 2005 .

[32]  G. Harrison.  Management of oesophageal and gastric cancer , 2006 .

[33]  K Sugimachi,et al.  Laparoscopy-assisted Billroth I gastrectomy. , 1994, Surgical laparoscopy & endoscopy.

[34]  K. Loughlin,et al.  The use of a Doppler probe in laparoscopic surgery. , 1992, Journal of laparoendoscopic surgery.

[35]  Hiroshi Ohtani,et al.  Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy. , 2006, World journal of gastroenterology.

[36]  G. Hanna,et al.  Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? , 2009, Surgical oncology.

[37]  Shahjahan Khan,et al.  Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma , 2008, Surgical Endoscopy.

[38]  M. Gagner,et al.  Comparison of laparoscopic and open gastrectomy for malignant disease , 2003, Surgical Endoscopy.

[39]  Y. Kodera,et al.  Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. , 2004, Journal of the American College of Surgeons.

[40]  Kozo Noguchi,et al.  A Meta-Analysis of Randomized Controlled Trials that Compared Laparoscopy-Assisted and Open Distal Gastrectomy for Early Gastric Cancer , 2010, Journal of Gastrointestinal Surgery.