title: Systematic review and meta-analysis of laparoscopic versus open distal gastrectomy.
abstract: BACKGROUND
  Laparoscopic distal gastrectomy has been increasingly utilized in the treatment of gastric adenocarcinoma. This study aims to compare the morbidity/mortality and postoperative outcomes of laparoscopic-assisted versus open distal gastrectomy since 2000.
  
  
  METHODS
  A comprehensive search of MEDLINE and EMBASE was conducted including studies published between 2000 and present.
  
  
  RESULTS
  Seventeen studies with a total of 7,109 distal gastrectomies (3,496 lap vs 3,613 open) were included. Across all studies, postoperative morbidity rates for laparoscopic gastrectomy were lower than that of open [median (range) 10 (0-36) % vs 17 (0-43) %]. Meta-analysis of postoperative morbidity rates in prospective studies only yielded pooled odds ratio of 0.52 (95 % CI 0.33-0.81) (P = 0.004). In-hospital mortality rates were comparable between the two (range: laparoscopic 0-3.3 vs open 0-6.7 %). The long-term oncological outcomes of resection were difficult to analyze given variable reporting but appeared similar between the two. Meta-analysis of prospective studies showed that laparoscopic-assisted distal gastrectomy was associated with significantly shorter hospital length of stay [standard mean difference (SMD) = -0.78 (95 % CI = -1.0 to -0.56)], comparable intraoperative bleeding [SMD = 0.64 (95 % CI = -1.3-0.0430) P = 0.066] and longer operative time compared to open gastrectomy [1.9 (95 % CI 0.05-3.8) P = 0.045, with P < 0.001].
  
  
  CONCLUSIONS
  This study supports the use of laparoscopic-assisted distal gastrectomy for treatment of gastric adenocarcinoma with evidence of comparable, if not better, short-term postoperative parameters when compared to open distal gastrectomy. The long-term oncological outcomes appear similar but may require more evaluation.
authors.affiliation: Department of Surgery, Westmead Hospital, PO Box 533, Wentworthville, NSW, 2145, Australia.
authors.forename: Qiuye
authors.initials: Q
authors.lastname: Cheng
authors.forename: Tony C Y
authors.initials: TC
authors.lastname: Pang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hollands
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Richardson
authors.forename: Henry
authors.initials: H
authors.lastname: Pleass
authors.forename: Emma S
authors.initials: ES
authors.lastname: Johnston
authors.forename: Vincent W T
authors.initials: VW
authors.lastname: Lam
mesh_terms: D016063:Blood Loss, Surgical; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
references.citation: Surg Endosc. 2005 Feb;19(2):168-73
references.pmid: 15580441
references.citation: Ann Surg. 2012 Jul;256(1):39-52
references.pmid: 22664559
references.citation: Ann Surg Oncol. 2009 Jun;16(6):1507-13
references.pmid: 19347407
references.citation: Surg Endosc. 2012 Mar;26(3):804-10
references.pmid: 22002202
references.citation: Surg Endosc. 2008 Jan;22(1):81-5
references.pmid: 17479314
references.citation: Surg Endosc. 2000 Jan;14(1):27-31
references.pmid: 10653231
references.citation: Scand J Surg. 2011;100(2):86-91
references.pmid: 21737383
references.citation: J Laparoendosc Adv Surg Tech A. 2006 Apr;16(2):119-23
references.pmid: 16646700
references.citation: Ann Surg Oncol. 1999 Jan-Feb;6(1):46-56
references.pmid: 10030415
references.citation: World J Surg. 2011 Feb;35(2):357-64
references.pmid: 21104250
references.citation: World J Gastroenterol. 2005 Dec 21;11(47):7508-11
references.pmid: 16437724
references.citation: Ann Surg. 2010 Mar;251(3):417-20
references.pmid: 20160637
references.citation: Surgery. 2005 Mar;137(3):317-22
references.pmid: 15746786
references.citation: Ann Surg. 2013 Apr;257(4):640-6
references.pmid: 23023204
references.citation: Ann Surg. 2005 Feb;241(2):232-7
references.pmid: 15650632
references.citation: Surg Endosc. 2008 May;22(5):1161-4
references.pmid: 18322744
references.citation: Dis Colon Rectum. 2001 Feb;44(2):207-14; discussion 214-6
references.pmid: 11227937
references.citation: Dig Surg. 2010;27(4):291-6
references.pmid: 20689290
references.citation: Ann Surg. 1999 Jan;229(1):49-54
references.pmid: 9923799
references.citation: Arch Surg. 2000 Jul;135(7):806-10
references.pmid: 10896374
references.citation: Dig Surg. 2011;28(4):245-51
references.pmid: 21654172
references.citation: Ann Surg. 2008 Nov;248(5):721-7
references.pmid: 18948798
references.citation: Surg Endosc. 2006 Nov;20(11):1738-43
references.pmid: 17024529
references.citation: Chin Med J (Engl). 2009 Jun 20;122(12):1404-7
references.pmid: 19567161
references.citation: Surg Endosc. 2011 Jan;25(1):140-5
references.pmid: 20535499
references.citation: Surg Today. 2010 Mar;40(3):228-33
references.pmid: 20180075
references.citation: Br J Surg. 1999 Apr;86(4):541-4
references.pmid: 10215833
references.citation: Gastric Cancer. 2001;4(2):93-7
references.pmid: 11706767
references.citation: World J Surg. 2013 Oct;37(10):2379-86
references.pmid: 23783252