title: Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  The possible advantages of laparoscopic (assisted) total gastrectomy (LTG) versus open total gastrectomy (OTG) have not been reviewed systematically. The aim of this study was to systematically review the short-term outcomes of LTG versus OTG in the treatment of gastric cancer.
  
  
  METHODS
  A systematic search of PubMed, Cochrane, CINAHL, and Embase was conducted. All original studies comparing LTG with OTG were included for critical appraisal. Data describing short-term outcomes were pooled and analyzed.
  
  
  RESULTS
  A total of eight original studies that compared LTG (n = 314) with OTG (n = 384) in patients with gastric cancer fulfilled quality criteria and were selected for review and meta-analysis. LTG compared with OTG was associated with a significant reduction of intraoperative blood loss (weighted mean difference = 227.6 ml; 95 % CI 144.3-310.9; p < 0.001), a reduced risk of postoperative complications (risk ratio = 0.51; 95 % CI 0.33-0.77), and shorter hospital stay (weighted mean difference 4.0 = days; 95 % CI 1.4-6.5; p < 0.001). These benefits were at the cost of longer operative time (weighted mean difference = 55.5 min; 95 % CI 24.8-86.2; p < 0.001). In-hospital mortality rates were comparable for LTG (0.9 %) and OTG (1.8 %) (risk ratio = 0.68; 95 % CI 0.20-2.36).
  
  
  CONCLUSIONS
  LTG shows better short term outcomes compared with OTG in eligible patients with gastric cancer. Future studies should evaluate 30- and 60-day mortality, radicality of resection, and long-term follow-up in LTG versus OTG, preferably in randomized trials.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. l.haverkamp@umcutrecht.nl
authors.forename: Leonie
authors.initials: L
authors.lastname: Haverkamp
authors.forename: Teus J
authors.initials: TJ
authors.lastname: Weijs
authors.forename: Pieter C
authors.initials: PC
authors.lastname: van der Sluis
authors.forename: Ingeborg
authors.initials: I
authors.lastname: van der Tweel
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000368:Aged; D001208:Asia; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005060:Europe; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D012306:Risk; D015983:Selection Bias; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome