title: Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer: a 10-y single-center experience with meta-analysis.
abstract: BACKGROUND
  Laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) are two commonly used methods of laparoscopic gastrectomy for gastric cancer. This study aimed to compare the short-term surgical outcomes of these two methods.
  
  
  METHODS
  A prospectively maintained gastric cancer database between October 2004 and February 2014 was reviewed and 115 patients underwent LADG and 198 patients underwent TLDG were included. The clinical characteristics and perioperative clinical outcomes of two groups were compared. Moreover, a systematic review and meta-analysis were conducted.
  
  
  RESULTS
  The mean operation time and blood loss were similar in two groups, as was the number of retrieved lymph nodes. There was no significant difference in time to first flatus, the time to restart oral intake, the length of the hospital stay after surgery, and postoperative complications. The meta-analysis revealed no significant differences in the operative time, surgical margin, time to first flatus, length of hospital stay, mortality, overall, and anastomosis-related complications among the groups. However, the intraoperative blood loss was lower in TLDG (weighted mean difference = 21.50 mL; 95% confidence interval: 9.79-33.22; P < 0.01), and number of retrieved lymph nodes was higher in TLDG (weighted mean difference = -1.56; 95% confidence interval: -2.69 to -0.44; P < 0.01).
  
  
  CONCLUSIONS
  TLDG is safe and feasible compared with LADG. However, it is difficult to identify the clinical advantages of TLDG over LADG based on our study. Thus, the choice of surgical approach mainly depends on the patient conditions and the preference of the patients or surgeons.
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China. Electronic address: mouyiping2002@163.com.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Mou
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
authors.forename: Xiao-Wu
authors.initials: XW
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Zhou
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
authors.forename: Jia-Qin
authors.initials: JQ
authors.lastname: Cai
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
authors.forename: Chao-Jie
authors.initials: CJ
authors.lastname: Huang
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Distal gastrectomy; Gastric cancer; Intracorporeal anastomosis; Laparoscopy; Meta-analysis