A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer.
BACKGROUND
We conducted a meta-analysis to evaluate and compare the advantages of laparoscopy-assisted distal gastrectomy (LADG) over open distal gastrectomy (ODG) for treating early gastric cancer (EGC).


METHODS
We searched MEDLINE, EMBASE, Science Citation Index, and Cochrane Controlled Trial Register for relevant papers published between January 1990 and January 2010 by using the following search terms: laparoscopy-assisted gastrectomy, laparoscopic gastrectomy, and early gastric cancer. The following data were analyzed: operative time, estimated blood loss, number of harvested lymph nodes, time required for resumption of oral intake, duration of hospital stay, frequency of analgesic administration, complications, tumor recurrence, and mortality.


RESULTS
We selected four papers reporting randomized control studies (RCTs) that compared LADG with ODG for EGC. Our meta-analysis included 267 patients with EGC; of these, 134 and 133 had undergone LADG and ODG, respectively. The volume of intraoperative blood loss, frequency of analgesic administration, and rate of complications were significantly lesser for LADG than for ODG. However, the time required for resumption of oral intake and duration of hospital stay did not significantly differ between LADG and ODG. The operative time for LADG was significantly longer than that for ODG; further, the number of harvested lymph nodes was significantly lesser in the LADG group than in the ODG group.


CONCLUSIONS
LADG is advantageous over ODG because it results in lesser blood loss, is less painful, and is associated with a low risk of complications. Additional RCTs that compare LADG and ODG and investigate the long-term oncological outcomes of LADG are required to determine the advantages of LADG over ODG.
Ohtani
Hiroshi
H
Department of Surgery, Osaka City Sumiyoshi Hospital, 1-2-16 Higashi-Kagaya, Suminoe-ku, Osaka 559-0012, Japan. m5051923@msic.med.osaka-cu.ac.jp
Tamamori
Yutaka
Y
Noguchi
Kozo
K
Azuma
Takashi
T
Fujimoto
Shunsuke
S
Oba
Hiroko
H
Aoki
Tetsuya
T
Minami
Mieko
M
Hirakawa
Kosei
K
D055088:Early Detection of Cancer; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*