Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials.
BACKGROUND
We carry out a meta-analysis to evaluate the effectiveness and safety of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy for resectable gastric cancer.


METHODS
We searched EMBASE, the Cochrane Library, PubMed, Science Citation Index (SCI), Chinese biomedicine literature database to identify randomized controlled trials (RCTs) from their inception to April 2012. Meta-analyses were performed using RevMan 5.0 software. It was in line with the preferred reporting items for systematic reviews and meta-analyses statement. The quality of evidence was assessed by GRADEpro 3.6.


RESULTS
Eight RCTs totaling 784 patients were analyzed. Compared with open gastrectomy group, no significant differences were found in postoperative mortality (OR = 1.49; 95 % CI 0.29-7.79), anastomotic leakage (OR = 1.02; 95 % CI 0.24-4.27) , overall mean number of harvested lymph nodes [weighed mean difference (MD) = -3.17; 95 % CI -6.39 to 0.05]; the overall postoperative complication morbidity (OR = 0.54; 95 % CI 0.36-0.82), estimated blood loss (MD = -107.23; 95 % CI -148.56 to -65.89,) frequency of analgesic administration (MD = -1.69; 95 % CI -2.18 to -1.21, P < 0.00001), incidence of pulmonary complications (OR = 0.43, 95 % CI 0.20-0.93, P = 0.03) were significantly less in LAG group; LAG had shorter time to start first flatus (MD = -0.23; 95 % CI -0.41 to -0.05) and decreased hospital stay (MD = -1.72; 95 % CI -3.40 to 0.04), but, LAG still had longer operation time (MD = 76.70; 95 % CI 51.54-101.87).


CONCLUSIONS
On the basis of this meta-analysis we conclude that although LAG was still a time-consuming and technically dependent procedure, it has the advantage of better short-term outcome. Long term survival data from other studies are urgently needed to estimate the survival benefit of this technique.
Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Dong Gang Road, Cheng Guan District, Lanzhou 730000, Gansu, China.
Lei
L
Jiang
Ke-Hu
KH
Yang
Quan-Lin
QL
Guan
Nong
N
Cao
Yan
Y
Chen
Peng
P
Zhao
Yao-Long
YL
Chen
Liang
L
Yao
D000700:Analgesics / Q000627:therapeutic use; D057868:Anastomotic Leak; D016063:Blood Loss, Surgical; D004363:Drug Utilization; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D061646:Operative Time; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000601:surgery*
D000700:Analgesics