title: Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy.
abstract: OBJECTIVE
  To elucidate the current status of laparoscopy-assisted distal gastrectomy (LADG) with regard to its short-term outcomes by comparing it with conventional open distal gastrectomy (CODG).
  
  
  METHODS
  Original articles published from January 1991 to August 2006 were searched in the MEDLINE, EMBASE, and Cochrane Controlled Trials Register. Clinical appraisal and data extraction were conducted independently by 2 reviewers. A meta-analysis was performed using a random effects model.
  
  
  RESULTS
  Outcomes of 1611 procedures from 4 randomized controlled trials and 12 retrospective studies were analyzed. Compared to CODG, LADG was a longer procedure (weighted mean difference [WMD] 54.3; 95% confidence interval [CI] 38.8 to 69.8; P < 0.001), but was associated with a lower associated morbidity (odds ratio [OR] 0.54; 95% CI 0.37 to 0.77; P < 0.001); this was most significant for postoperative ileus (OR 0.27; 95% CI 0.09 to 0.84; P = 0.02). There was no significant difference between the two groups in anastomotic, pulmonary, and wound complications and mortality. Duration from surgery to first passage of flatus was faster (WMD -0.68; 95% CI -0.85 to -0.50; P < 0.001) and the frequency of additional analgesic requirement (WMD -1.36; 95% CI -2.44 to -0.28; P = 0.01), and duration of hospital stay (WMD -5.51; 95% CI -7.61 to -3.42; P < 0.001) were significantly lower after LADG. However, a significantly higher number of lymph nodes were dissected by CODG (WMD -4.35; 95% CI -5.73 to -2.98; P < 0.001).
  
  
  CONCLUSIONS
  LADG for early gastric cancer is associated with a lower morbidity, less pain, faster bowel function recovery, and shorter hospital stay.
authors.affiliation: Department of Surgery, Osaka City Sumiyoshi Hospital, 1-2-16, Higashi-Kagaya, Osaka 559-0012, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Hosono
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Arimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtani
authors.forename: Yoshitetsu
authors.initials: Y
authors.lastname: Kanamiya
mesh_terms: D005743:Gastrectomy / Q000379:methods* / Q000401:mortality*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods / Q000401:mortality; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome