Minimally Invasive Versus Open Total Gastrectomy for Gastric Cancer: A Systematic Review and Meta-analysis of Short-Term Outcomes and Completeness of Resection : Surgical Techniques in Gastric Cancer.
Minimally invasive surgical techniques for gastric cancer are gaining more acceptance worldwide as an alternative to open resection. In order to assess the role of minimally invasive and open techniques in total gastrectomy for cancer, a systematic review and meta-analysis was performed. Articles comparing minimally invasive versus open total gastrectomy were reviewed, collected from the Medline, Embase, and Cochrane databases. Two different authors (JS and NW) independently selected and assessed the articles. Outcomes regarding operative results, postoperative recovery, morbidity, mortality, and oncological outcomes were analyzed. Statistical analysis portrayed the weighted mean difference (WMD) with a 95% confidence interval and odds ratio (OR). Out of 1242 papers, 12 studies were selected, including a total of 1360 patients, of which 592 underwent minimally invasive total gastrectomy (MITG). Compared to open total gastrectomy (OTG), MITG showed a longer operation time (WMD: 48.06 min, P < 0.00001), less operative blood loss (WMD: -160.70 mL, P < 0.00001), faster postoperative recovery, measured as shorter time to first flatus (WMD -1.05 days, P < 0.00001), shorter length of hospital stay (WMD: -2.43 days, P = 0.0002), less postoperative complications (OR 0.66, P = 0.02), similar mortality rates (OR 0.60, P = 0.52), and similar rates in lymph node yield (WMD -2.30, P = 0.06). Minimally invasive total gastrectomy showed faster postoperative recovery and less postoperative complications, whereas completeness of the resection was similar in both groups. Duration of surgery was longer in the minimally invasive group. Only comparative non-randomized studies were available, further emphasizing the need for a prospective randomized trial comparing MITG and OTG.
Department of Gastrointestinal Surgery, VU University Medical Centre, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands. je.straatman@vumc.nl.
Jennifer
J
Straatman
Department of Gastrointestinal Surgery, VU University Medical Centre, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
Nicole
N
van der Wielen
Department of Gastrointestinal Surgery, VU University Medical Centre, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
Miguel A
MA
Cuesta
Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
Elly S M
ES
de Lange-de Klerk
Medical Library, VU University Medical Centre, Amsterdam, The Netherlands.
Elise P
EP
Jansma
Department of Gastrointestinal Surgery, VU University Medical Centre, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
Donald L
DL
van der Peet
D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D014943:Global Health; D006801:Humans; D015994:Incidence; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors