title: Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) and open total gastrectomy (OTG) for gastric cancer.
  
  
  METHODS
  A comprehensive search of PubMed, Cochrane Library, Web of Science and BIOSIS Previews was performed to identify studies that compared LATG and OTG. The following factors were checked: operating time, blood loss, harvested lymph nodes, flatus time, hospital stay, mortality and morbidity. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.
  
  
  RESULTS
  Nine studies with 1221 participants were included (436 LATG and 785 OTG). Compared to OTG, LATG involved a longer operating time [weighted mean difference (WMD) = 57.68 min, 95%CI: 30.48-84.88; P < 0.001]; less blood loss [standard mean difference (SMD) = -1.71; 95%CI: -2.48 - -0.49; P < 0.001]; earlier time to ﬂatus (WMD= -0.76 d; 95%CI: -1.22 - -0.30; P < 0.001); shorter hospital stay (WMD = -2.67 d; 95%CI: -3.96 - -1.38, P < 0.001); and a decrease in medical complications (RR = 0.41, 95%CI: 0.19-0.90, P = 0.03). The number of harvested lymph nodes, mortality, surgical complications, cancer recurrence rate and long-term survival rate of patients undergoing LATG were similar to those in patients undergoing OTG.
  
  
  CONCLUSIONS
  Despite a longer operation, LATG can be performed safely in experienced surgical centers with a shorter hospital stay and fewer complications than open surgery.
authors: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors: Ke
authors: K
authors: Chen
authors: Xiao-Wu
authors: XW
authors: Xu
authors: Ren-Chao
authors: RC
authors: Zhang
authors: Yu
authors: Y
authors: Pan
authors: Di
authors: D
authors: Wu
authors: Yi-Ping
authors: YP
authors: Mou
mesh_terms: D016009:Chi-Square Distribution; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Gastric cancer; Laparoscopy; Meta-analysis; Total gastrectomy
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