title: Laparoscopic versus open gastrectomy with D2 lymph node dissection for gastric cancer: a meta-analysis.
abstract: BACKGROUND
  Nowadays laparoscopic gastrectomy with D2 lymph node dissection (LGD2) is used for gastric cancer, which provides an alternative to open radical gastrectomy (OGD2). But it has not gained wide acceptance, and its oncological safety remains controversial. The aim of this study is to evaluate the efficiency and safety of LGD2 through a meta-analysis.
  
  
  METHODS
  Original articles of clinical trials comparing LGD2 and OGD2 for gastric cancer, published in English language from January 2001 to April 2010 were searched in the MEDLINE, Current Contents, and Pubmed. Strict literature appraisal and data extraction were carried out independently by 2 reviewers and then a meta-analysis was performed using RevMan 4.2.5 to evaluate the items of operative time, blood loss, harvested lymph nodes, analgesic medication, first flatus day, postoperative hospital stay, postoperative complications, and cumulative survival rate.
  
  
  RESULTS
  Ten trials were involved in the meta-analysis, concerning a total of 1039 patients (495 in LGD2 and 544 in OGD2). Compared with OGD2, LGD2 showed advantages of less blood loss during operation [weighed mean difference (WMD), -114.98; 95% confidence interval (CI), -160.44 to -69.52; P<0.00001], less postoperative pain (WMD, -0.89; 95% CI, -1.54 to -0.32; P=0.002), earlier passage of flatus (WMD, -0.84; 95% CI, -1.25 to -0.43; P<0.0001), shorter hospital stay (WMD, -3.27; 95% CI, -4.54 to -2.00; P<0.00001), and less postoperative complications [odds ratio (OR), 0.56; 95% CI, 0.32-0.59; P=0.03]; but with longer operative time [WMD, 57.14; 95% CI, 38.12-76.15; P<0.00001]. There were no significant differences between LGD2 and OGD2 in harvested lymph nodes (WMD, -2.07; 95% CI, -4.27 to -0.14; P=0.07) and overall survival rate of 11 to 60 months' follow-up (OR, 1.44; 95% CI, 0.92-2.27; P=0.11).
  
  
  CONCLUSIONS
  The results of this meta-analysis suggest that LGD2 results in less blood loss and postoperative complications and also less pain and faster bowel function recovery, with similar harvested lymph nodes and overall survival rate comparing to OGD2. However, we also see the need for further high-quality randomized controlled trials comparing the 2 procedures.
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. drwhb@21cn.com
authors.forename: Hong-Bo
authors.initials: HB
authors.lastname: Wei
authors.forename: Bo
authors.initials: B
authors.lastname: Wei
authors.forename: Cui-Ling
authors.initials: CL
authors.lastname: Qi
authors.forename: Tu-Feng
authors.initials: TF
authors.lastname: Chen
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.forename: Zong-Heng
authors.initials: ZH
authors.lastname: Zheng
authors.forename: Jiang-Long
authors.initials: JL
authors.lastname: Huang
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Fang
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002986:Clinical Trials as Topic; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate
chemical_list: D000700:Analgesics