title: Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies.
abstract: BACKGROUND
  In some meta-analyses of randomized controlled trials (RCTs), laparoscopic or laparoscopy-assisted distal gastrectomy (LDG) had several short-term advantages. However, several specific postoperative complications (PCs) were not analyzed sufficiently.
  
  
  METHODS
  RCTs and case-controlled studies (CCSs) comparing postoperative complications between LDG and open distal gastrectomy (ODG) were identified in PubMed and Embase. Studies in which patients' status, extent of lymph-node dissection, or reconstruction procedures were matched between the groups were included in a meta-analysis. Postoperative complications such as surgical-site infection (SSI; which included wound infection and intra-abdominal abscess), leakage, anastomotic stenosis, bleeding, ileus, delayed gastric emptying, pneumonia were evaluated in a meta-analysis performed using Review Manager version 5.2 software.
  
  
  RESULTS
  This meta-analysis included a total of 2144 patients (1065 underwent LDG and 1079 underwent ODG) from 5 RCTs and 13 CCSs. SSI and wound infections were reported in 14 studies, and the incidences were significantly lower in LDG than in ODG (n = 1737; odds ratio [OR] 0.50, 95% confidence interval [CI] 0.29-0.85, P = 0.01, I(2) = 0%, and OR 0.46, 95% CI 0.24-0.88, P = 0.02; I(2) = 0%). There were no significant differences in intra-abdominal abscess or other specific complications between the procedures.
  
  
  CONCLUSIONS
  LDG was associated with a lower incidence of SSI, especially wound infection, as compared with ODG in a meta-analysis of both RCTs and CCSs.
authors: Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan. Electronic address: m-inokuchi.srg2@tmd.ac.jp.
authors: Mikito
authors: M
authors: Inokuchi
authors: Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
authors: Hirofumi
authors: H
authors: Sugita
authors: Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
authors: Sho
authors: S
authors: Otsuki
authors: Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
authors: Yuya
authors: Y
authors: Sato
authors: Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
authors: Masatoshi
authors: M
authors: Nakagawa
authors: Center of Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
authors: Kazuyuki
authors: K
authors: Kojima
mesh_terms: D016022:Case-Control Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
keywords: Gastric cancer; Laparoscopic gastrectomy; Surgical site infection