[Totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer: a meta-analysis].
To compare the safety and efficacy of totally laparoscopic distal gastrectomy (TLDG) with laparoscopic assisted distal gastrectomy (LADG) for gastric cancer by meta-analysis.



The literature on comparative studies of TLDG and LADG up to June 2014 were extensively retrieved from database PubMed, Cochrane library, Web of Science, and Biosis Previews. The operation time, blood loss, time to flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity, times of analgestic requirement, pain score, and the level of C-reactive protein (CRP) on postoperative day 1 and 7 were analyzed. The statistical analysis was performed with RevMan 5.1 software.



Seven studies met the inclusion criteria for meta-analysis. A total of 1783 Patients were included for meta-analysis, among whom 727 cases underwent TLDG and 1056 underwent LADG. Comparing with LADG, TLDG experienced less blood loss [weighted mean difference (WMD)=22.86 ml，95% confidence interval (CI): 12.0-33.72, P<0.01)], less times of analgesic requirement (WMD=0.58, 95% CI: 0.35-0.81, P< 0.01)，less pain score on postoperative day 1 and day 3 (day1: WMD=0.60, 95% CI: 0.20-0.99, P < 0.01; day3: WMD=0.36, 95% CI: 0.24-0.48, P < 0.01), earlier beginning to take diet (WMD=0.66, 95% CI: 0.13-1.19, P=0.01). The operation time, postoperative hospital stay, overall morbidity and anastomosis-related morbidity, and the level of CRP on postoperative day 1 and 7 were similar between two groups (Ps>0.05).



TLDG is a safe and feasible procedure with less blood loss, less pain, and quicker recovery than those of LADG.
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Xiao-wu
XW
Xu
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Yu
Y
Pan
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Ke
K
Chen
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Jia-qin
JQ
Cai
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Di
D
Wu
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Ren-chao
RC
Zhang
Department of General Surgery，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China.
Yi-ping
YP
Mou
D000368:Aged; D002097:C-Reactive Protein; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D013274:Stomach Neoplasms / Q000601:surgery*
D002097:C-Reactive Protein