Oncologic value of laparoscopy-assisted distal gastrectomy for advanced gastric cancer: A systematic review and meta-analysis.
BACKGROUND
The oncologic validity of laparoscopic-assisted distal gastrectomy (LADG) in the treatment of advanced gastric cancer (AGC) remains controversial. This study is a systematic review and meta-analysis of the available evidence.


METHODS
A comprehensive search was performed between 2008 and 2014 to identify comparative studies evaluating morbidity/mortality, oncologic surgery-related outcomes, recurrence and survival rates. Data synthesis and statistical analysis were carried out using RevMan 5.2 software.


RESULTS
Eight studies with a total of 1456 patients were included in this analysis. The complication rate was lower in LADG [odds ratio (OR) 0.59; 95% confidence interval (CI) = 0.42-0.83; P < 0.002]. The in-hospital mortality rate was comparable (OR 1.22; 95% CI = 0.28-5-29, P = 0.79). There was no significant difference in the number of harvested lymph nodes, resection margins, cancer recurrence rate, cancer-related mortality or overall and disease-free survival (OS and DFS, respectively) rates between the laparoscopic and the open groups (P > 0.05).


CONCLUSIONS
The current study supports the view that LADG for AGC is a feasible, safe and effective procedure in selected patients. Adequate lymphadenectomy, resection margins, recurrence, cancer-related mortality and long-term outcomes appear equivalent to open distal gastrectomy (ODG).
Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Paolo
P
Aurello
Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Andrea
A
Sagnotta
Biostatistic Unit, Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
Irene
I
Terrenato
Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Giammauro
G
Berardi
Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Giuseppe
G
Nigri
Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Francesco
F
D'Angelo
Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Giovanni
G
Ramacciato