title: Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  The objective of this study was to evaluate the feasibility, safety, and potential benefits of laparoscopic gastrectomy (LG) comparing with open gastrectomy (OG) in elderly population.
  
  
  METHODS
  Studies comparing LG with OG for elderly population with gastric cancer, published between January 1994 and July 2015, were identified in the PubMed, Embase, and ISI Web of Science databases. Operative outcomes (intraoperative blood loss, operative time, and the number of lymph nodes harvested) and postoperative outcomes (time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity) were included and analyzed. The Newcastle-Ottawa Scale was used to assess the quality of the pooled study. A funnel plot was used to evaluate the publication bias.
  
  
  RESULTS
  Seven studies totaling 845 patients were included in the meta-analysis. LG in comparison to OG showed less intraoperative blood loss (weighted mean difference (WMD) -127.47; 95% confidence interval (CI) -202.79 to -52.16; P < 0.01), earlier time to first ambulation (WMD -2.07; 95% CI -2.84 to -1.30; P < 0.01), first flatus (WMD -1.04; 95% CI -1.45 to -0.63; P < 0.01), and oral intake (WMD -0.94; 95% CI -1.11 to -0.77; P < 0.01), postoperative hospital stay (WMD -5.26; 95% CI -7.58 to -2.93; P < 0.01), lower overall postoperative complication rate (odd ratio (OR) 0.39; 95% CI 0.28 to 0.55; P < 0.01), less surgical complications (OR 0.47; 95% CI 0.32 to 0.69; P < 0.01), medical complication (OR 0.35; 95% CI 0.22 to 0.56; P < 0.01), incisional complication (OR 0.40; 95% CI 0.19 to 0.85; P = 0.02), and pulmonary infection (OR 0.49; 95% CI 0.26 to 0.93; P = 0.03). No significant differences were observed between LG and OG for the number of harvested lymph nodes. However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01).
  
  
  CONCLUSIONS
  LG is a feasible and safe approach for elderly patients with gastric cancer. Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.
authors.forename: Jin-fa
authors.initials: JF
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.
authors.forename: Song-ze
authors.initials: SZ
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.
authors.forename: Neng-yun
authors.initials: NY
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.
authors.forename: Zong-yang
authors.initials: ZY
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.
authors.forename: Ji-ye
authors.initials: JY
authors.lastname: Feng
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.
authors.forename: Li-ping
authors.initials: LP
authors.lastname: Ying
authors.affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China. zhangjingjing_nb@163.com.
authors.forename: Jing-jing
authors.initials: JJ
authors.lastname: Zhang
mesh_terms: D000368:Aged; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Elderly; Gastrectomy; Gastric cancer; Laparoscopy; Meta-analysis