title: Surgical interventions for gastric cancer: a review of systematic reviews.
abstract: OBJECTIVE
  To evaluate methodological quality and the extent of concordance among meta-analysis and/or systematic reviews on surgical interventions for gastric cancer (GC).
  
  
  METHODS
  A comprehensive search of PubMed, Medline, EMBASE, the Cochrane library and the DARE database was conducted to identify the reviews comparing different surgical interventions for GC prior to April 2014. After applying included criteria, available data were summarized and appraised by the Oxman and Guyatt scale.
  
  
  RESULTS
  Fifty six reviews were included. Forty five reviews (80.4%) were well conducted, with scores of adapted Oxman and Guyatt scale ≥ 14. The reviews differed in criteria for avoiding bias and assessing the validity of the primary studies. Many primary studies displayed major methodological flaws, such as randomization, allocation concealment, and dropouts and withdrawals. According to the concordance assessment, laparoscopy-assisted gastrectomy (LAG) was superior to open gastrectomy, and laparoscopy-assisted distal gastrectomy was superior to open distal gastrectomy in short-term outcomes. However, the concordance regarding other surgical interventions, such as D1 vs. D2 lymphadenectomy, and robotic gastrectomy vs. LAG were absent.
  
  
  CONCLUSIONS
  Systematic reviews on surgical interventions for GC displayed relatively high methodological quality. The improvement of methodological quality and reporting was necessary for primary studies. The superiority of laparoscopic over open surgery was demonstrated. But concordance on other surgical interventions was rare, which needed more well-designed RCTs and systematic reviews.
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, Centre of Gastric Cancer, The First Affiliated Hospital, Sun Yat-sen University Guangzhou 510080, Guangdong Province, P. R. China.
authors.forename: Weiling
authors.initials: W
authors.lastname: He
authors.affiliation: Musculoskeletal Center, Department of Orthopaedic Surgery, The First Affiliated Hospital, Sun Yat-sen University Guangzhou City 510080, Guangdong Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Tu
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University Guangzhou City 510080, Guangdong Province, China.
authors.forename: Zijun
authors.initials: Z
authors.lastname: Huo
authors.affiliation: Department of Molecular & Medical Genetics, Oregon Health & Science University 3181 S.W. Sam Jackson Park Rd. Portland, Oregon 97239, USA.
authors.forename: Yuhuang
authors.initials: Y
authors.lastname: Li
authors.affiliation: The Sixth Affiliated Hospital of Sun Yat-sen University Guangzhou City 510080, Guangdong Province, China.
authors.forename: Jintao
authors.initials: J
authors.lastname: Peng
authors.affiliation: The First Affiliated Hospital, Guangzhou University of Chinese Medicine Guangzhou 510405, Guangdong Province, P. R. China.
authors.forename: Zhenwen
authors.initials: Z
authors.lastname: Qiu
authors.affiliation: The First Affiliated Hospital, Guangzhou University of Chinese Medicine Guangzhou 510405, Guangdong Province, P. R. China.
authors.forename: Dandong
authors.initials: D
authors.lastname: Luo
authors.affiliation: Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Zunfu
authors.initials: Z
authors.lastname: Ke
authors.affiliation: School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center Guangzhou 510006, Guangdong Province, P. R. China.
authors.forename: Xinlin
authors.initials: X
authors.lastname: Chen
keywords: Gastric cancer; meta-analysis; methodological quality; surgical intervention; systematic review