Totally laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis of outcomes compared with open surgery.
OBJECTIVE
To systematically review the surgical outcomes of totally laparoscopic gastrectomy (TLG) vs open gastrectomy (OG) for gastric cancer.


METHODS
A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted. All original studies comparing TLG with OG were included for critical appraisal. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.


RESULTS
One RCT and 13 observational studies involving 1532 patients were included (721 TLG and 811 OG). TLG was associated with longer operation time [weighted mean difference (WMD) = 58.04 min, 95%CI: 37.77-78.32, P < 0.001], less blood loss [WMD = -167.57 min, 95%CI: -208.79-(-126.34), P < 0.001], shorter hospital stay [WMD = -3.75 d, 95%CI: -4.88-(-2.63), P < 0.001] and fewer postoperative complications (RR = 0.71, 95%CI: 0.58-0.86, P < 0.001). The number of harvested lymph nodes, surgical margin, mortality and cancer recurrence rate were similar between the two groups.


CONCLUSIONS
TLG may be a technically safe, feasible and favorable approach in terms of better cosmesis, less blood loss and faster recovery compared with OG.
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Ke
K
Chen
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Yu
Y
Pan
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Jia-Qin
JQ
Cai
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Xiao-Wu
XW
Xu
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Di
D
Wu
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Yi-Ping
YP
Mou
D016063:Blood Loss, Surgical / Q000517:prevention & control; D016009:Chi-Square Distribution; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
Gastrectomy; Gastric cancer; Intracorporeal anastomosis; Laparoscopy; Meta-analysis; Survival