title: Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis.
abstract: OBJECTIVE
  To conduct a meta-analysis comparing laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) for the treatment of gastric cancer.
  
  
  METHODS
  Major databases such as Medline (PubMed), Embase, Academic Search Premier (EBSCO), Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013. Evaluated endpoints were operative, postoperative and oncological outcomes. Operative outcomes included operative time and intraoperative blood loss. Postoperative recovery included time to first ﬂatus, time to first oral intake, hospital stay and analgesics use. Postoperative complications comprised morbidity, anastomotic leakage, anastomotic stenosis, ileus, bleeding, abdominal abscess, wound problems and mortality. Oncological outcomes included positive resection margins, number of retrieved lymph nodes, and proximal and distal resection margins. The pooled effect was calculated using either a fixed effects or a random effects model.
  
  
  RESULTS
  Fifteen non-randomized comparative studies with 2022 patients were included (LTG - 811, OTG - 1211). Both groups had similar short-term oncological outcomes, analgesic use (WMD -0.09; 95%CI: -2.39-2.20; P = 0.94) and mortality (OR = 0.74; 95%CI: 0.24-2.31; P = 0.61). However, LTG was associated with a lower intraoperative blood loss (WMD -201.19 mL; 95%CI: -296.50--105.87 mL; P < 0.0001) and overall complication rate (OR = 0.73; 95%CI: 0.57-0.92; P = 0.009); fewer wound-related complications (OR = 0.39; 95%CI: 0.21-0.72; P = 0.002); a quicker recovery of gastrointestinal motility with shorter time to ﬁrst ﬂatus (WMD -0.82; 95%CI: -1.18--0.45; P < 0.0001) and oral intake (WMD -1.30; 95%CI: -1.84--0.75; P < 0.00001); and a shorter hospital stay (WMD -3.55; 95%CI: -5.13--1.96; P < 0.0001), albeit with a longer operation time (WMD 48.25 min; 95%CI: 31.15-65.35; P < 0.00001), as compared with OTG.
  
  
  CONCLUSIONS
  LTG is safe and effective, and may offer some advantages over OTG in the treatment of gastric cancer.
authors.affiliation: Jun-Jie Xiong, Chun-Lu Tan, Neng-Wen Ke, Si-Ming Xie, Xun Ran, Hao Zhang, Yong-Hua Chen, Xu-Bao Liu, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Xiong
authors.forename: Quentin M
authors.initials: QM
authors.lastname: Nunes
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Chun-Lu
authors.initials: CL
authors.lastname: Tan
authors.forename: Neng-Wen
authors.initials: NW
authors.lastname: Ke
authors.forename: Si-Ming
authors.initials: SM
authors.lastname: Xie
authors.forename: Xun
authors.initials: X
authors.lastname: Ran
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Yong-Hua
authors.initials: YH
authors.lastname: Chen
authors.forename: Xu-Bao
authors.initials: XB
authors.lastname: Liu
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; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Gastric cancer; Laparoscopic assisted total gastrectomy; Laparoscopic total gastrectomy; Meta-analysis; Open total gastrectomy