Laparoscopic versus open gastrectomy for gastric cancer

Abstract

Background: Compared with open gastrectomy (OG), laparoscopic gastrectomy (LG) for gastric cancer has achieved rapid development and popularities in the past decades. However, lack of comprehensive analysis in long-term oncological outcomes such as recurrence and mortality hinder its full support as a valid procedure. Therefore, there are still debates on whether one of these options is superior.

Aim: To evaluate the primary and secondary outcomes of laparoscopic versus open gastrectomy for gastric cancer patients METHODS: Two authors independently extracted study data. Risk ratio (RR) with 95% confidence interval (CI) was calculated for binary outcomes, mean difference (MD) or the standardized mean difference (SMD) with 95% CI for continuous outcomes, and the hazard ratio (HR) for time-to-event outcomes. Review Manager 5.3 and STATA software were used for the meta-analysis.

Results: Seventeen randomized controlled trials (RCTs) involving 5204 participants were included in this meta-analysis. There were no differences in the primary outcomes including the number of lymph nodes harvested during operation, severe complications, short-term and long-term recurrence, and mortality. As for secondary outcomes, compared with the OG group, longer operative time was required for patients in the LG group (MD = 58.80 min, 95% CI = [45.80, 71.81], P < 0.001), but there were less intraoperative blood loss (MD = - 54.93 ml, 95% CI = [- 81.60, - 28.26], P < 0.001), less analgesic administration (frequency: MD = - 1.73, 95% CI = [- 2.21, - 1.24], P < 0.001; duration: MD = - 1.26 days, 95% CI = [- 1.40, - 1.12], P < 0.001), shorter hospital stay (MD = - 1.37 days, 95% CI = [- 2.05, - 0.70], P < 0.001), shorter time to first flatus (MD = - 0.58 days, 95% CI = [- 0.79, - 0.37], P < 0.001), ambulation (MD = - 0.50 days, 95% CI = [- 0.90, - 0.09], P = 0.02) and oral intake (MD = - 0.64 days, 95% CI = [- 1.24, - 0.03], P < 0.04), and less total complications (RR = 0.81, 95% CI = [0.71, 0.93], P = 0.003) in the OG group. There was no difference in blood transfusions (number, quantity) between these two groups. Subgroup analysis, sensitivity analysis, and the adjustment of Duval's trim and fill methods for publication bias did not change the conclusions.

Conclusion: LG was comparable to OG in the primary outcomes and had some advantages in secondary outcomes for gastric cancer patients. LG is superior to OG for gastric cancer patients.

Keywords: Gastric cancer; Laparoscopic gastrectomy (LG); Meta-analysis; Mortality; Open gastrectomy (OG); Recurrence.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Flowchart of literature search and study selection process

Fig. 2

Risk of bias. a Risk of bias graph. b Risk of bias summary

Fig. 3

Forest plot between laparoscopy gastrectomy (LG) and open gastrectomy (OG) group on primary outcomes. a The number of lymph nodes harvested during surgery. b Severe complications. c Long-term recurrence. d Short-term mortality. e Long-term mortality

Fig. 4

Forest plot between the LG and OG group on secondary outcomes. a Operative time. b Intraoperative blood loss on secondary outcomes. c Time to first flatus. d Time to first ambulation. e Time to first oral intake

Fig. 5

Forest plot between the LG and OG group on secondary outcomes. a Hospital stay. b The number of patients who need blood transfusion. c The quantity of blood transfusion. d The frequency of analgesic administration. e The duration of analgesic administration. f Total complications

Fig. 6

Filled funnel plot with pseudo 95% confidence limits on time to first flatus