title: Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis.
abstract: OBJECTIVE
  We conducted a meta-analysis to compare surgical and oncologic outcomes of patients with gastric gastrointestinal stromal tumors (GISTs) undergoing laparoscopic resection surgery (LAP) and open resection surgery (OPEN).
  
  
  METHODS
  PubMed, Ovid, Web of Science, Cochrane, CNKI, and Chinese Biomedical Database were searched. Statistical analysis was carried out by RevMan 5.0 software. The quality of evidence was assessed by the Newcastle-Ottawa scale. A decision tree analysis model was constructed to evaluate the treatment strategy.
  
  
  RESULTS
  Seventeen studies involving 776 participants were included for the meta-analysis. The meta-analysis results showed that, compared with OPEN, LAP indicates potentially favorable outcomes in terms of intraoperative blood loss [weighted mean difference (WMD), -60.67; 95% confidence interval (95% CI), -116.66 to -4.69], time to first flatus (WMD, -1.19; 95% CI, -1.65 to -0.73), time to oral intake (WMD, -1.26; 95% CI, -1.89 to -0.63), and hospital stay (WMD, -2.62; 95% CI, -3.25 to -1.99). There were no differences in terms of the operative time, overall complication, and recurrence. Decision analysis showed that LAP was the strategy with a higher overall success (93%) compared with OPEN (88%).
  
  
  CONCLUSIONS
  This meta-analysis showed that LAP for gastric GISTs was associated with less blood loss, earlier return of bowel function, earlier resumption of diet, and shorter length of hospital stay when compared with OPEN; however, LAP and OPEN had similar operative time, overall complication, and recurrence. The LAP might be superior to OPEN for the patients with GIST <5 cm. Methodologically, high-quality comparative studies are needed for further evaluation.
authors.affiliation: Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China. liangjiwang1985@163.com
authors.forename: Ji-Wang
authors.initials: JW
authors.lastname: Liang
authors.forename: Zhi-Chao
authors.initials: ZC
authors.lastname: Zheng
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Liu
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D017594:Publication Bias; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome