Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis

Weizhi Wang, Xiaoyu Zhang, Chen Shen, Xiaofei Zhi, Baolin Wang, Zekuan Xu, Weizhi Wang, Xiaoyu Zhang, Chen Shen, Xiaofei Zhi, Baolin Wang, Zekuan Xu

Abstract

Objective: To expand the current knowledge on the feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric cancer in comparison with open total gastrectomy (OTG).

Background: Additional studies comparing laparoscopic versus open total gastric resection have been published, and it is necessary to update the meta-analysis of this subject.

Methods: Original articles compared LTG and OTG for gastric cancer, which published in English from January 1990 to July 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, proximal resection margin, analgesic medication, first flatus day, first oral intake, postoperative hospital stay, postoperative complications, hospital mortality, 5-year overall survival (OS) and disease-free survival (DFS) were compared using STATA version 10.1.

Results: 17 studies were selected in this analysis, which included a total of 2313 patients (955 in LTG and 1358 in OTG). LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. The number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar.

Conclusion: LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time. There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG. A positive trend was indicated towards LTG. So LTG can be performed as an alternative to OTG by the experienced surgeons in high-volume centers. Whereas, due to the relative small sample size of long-term outcomes and lack of randomized control trials, more studies are required.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Articles identified with criteria for…
Figure 1. Articles identified with criteria for inclusion and exclusion.
Figure 2. Analysis comparing (A) operative time,…
Figure 2. Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.
Figure 3. Analysis comparing (A) analgesic medication,…
Figure 3. Analysis comparing (A) analgesic medication, (B) first flatus day, (C) first oral intake, and (D) postoperative hospital stay.
Figure 4. Analysis comparing (A) postoperative complications,…
Figure 4. Analysis comparing (A) postoperative complications, (B) postoperative complications under D2 dissection, (C) 5-year OS and (D) 5-year DFS.
Figure 5. Funnel plots of each outcome.
Figure 5. Funnel plots of each outcome.
A, operative time; B, blood loss; C, harvested lymph nodes; D, first flatus day; E, first oral intake; F, hospital stay; G, postoperative complications.

References

    1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4: 146–148.
    1. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, et al. (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131: S306–311.
    1. Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19: 1172–1176.
    1. Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19: 168–173.
    1. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, et al. (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248: 721–727.
    1. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255: 446–456.
    1. Song KY, Kim SN, Park CH (2008) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 22: 655–659.
    1. Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years' experience. J Surg Oncol 98: 515–519.
    1. Kawamura H, Homma S, Yokota R, Yokota K, Watarai H, et al. (2008) Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World J Surg 32: 2366–2370.
    1. Hamabe A, Omori T, Tanaka K, Nishida T (2012) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26: 1702–1709.
    1. Takiguchi S, Sekimoto M, Fujiwara Y, Miyata H, Yasuda T, et al. (2005) A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis. Surg Today 35: 896–899.
    1. Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, et al. (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100: 392–395.
    1. Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, et al. (2013) Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27: 1509–1520.
    1. GA W, L B, D OC, B S, D H, et al... (2003) An Evaluation of the Newcastle Ottawa Scale: An Assessment Tool for Evaluating the Quality of Non-Randomized Studies. In XI Cochrane Colloquium VolO-63p26 Barcelona: XI International Cochrane Colloquium Book of Abstracts.
    1. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5: 13.
    1. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17: 2815–2834.
    1. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8: 16.
    1. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7: 177–188.
    1. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748.
    1. Galbraith RF (1988) Graphical display of estimates having differing standard errors. Technometrics 30: 271–81.
    1. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315: 629–634.
    1. Dulucq JL, Wintringer P, Stabilini C, Solinas L, Perissat J, et al. (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc 19: 933–938.
    1. Usui S, Yoshida T, Ito K, Hiranuma S, Kudo SE, et al. (2005) Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surg Laparosc Endosc Percutan Tech 15: 309–314.
    1. Mochiki E, Toyomasu Y, Ogata K, Andoh H, Ohno T, et al. (2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22: 1997–2002.
    1. Kim SG, Lee YJ, Ha WS, Jung EJ, Ju YT, et al. (2008) LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer? J Laparoendosc Adv Surg Tech A 18: 572–578.
    1. Topal B, Leys E, Ectors N, Aerts R, Penninckx F (2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22: 980–984.
    1. Kawamura H, Yokota R, Homma S, Kondo Y (2009) Comparison of invasiveness between laparoscopy-assisted total gastrectomy and open total gastrectomy. World J Surg 33: 2389–2395.
    1. Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, et al. (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc 23: 2416–2423.
    1. Du J, Zheng J, Li Y, Li J, Ji G, et al. (2010) Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer–reports of 82 cases. Hepatogastroenterology 57: 1589–1594.
    1. Kim MG, Kim BS, Kim TH, Kim KC, Yook JH (2011) The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer. J Korean Surg Soc 80: 245–250.
    1. Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, et al. (2012) Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 26: 3273–3281.
    1. Arrington AK, Nelson R, Chen SL, Ellenhorn JD, Garcia-Aguilar J, et al. (2012) The evolution of surgical technique for total gastrectomy over a 12-year period: a single institution's experience. Am Surg 78: 1054–1058.
    1. Kunisaki C, Makino H, Kosaka T, Oshima T, Fujii S, et al. (2012) Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study. Surg Endosc 26: 804–810.
    1. Siani LM, Ferranti F, De Carlo A, Quintiliani A (2012) Completely laparoscopic versus open total gastrectomy in stage I-III/C gastric cancer: safety, efficacy and five-year oncologic outcome. Minerva Chir 67: 319–326.
    1. Jeong O, Jung MR, Kim GY, Kim HS, Ryu SY, et al. (2012) Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method. J Am Coll Surg 216(2): 184–91.
    1. Guan G, Jiang W, Chen Z, Liu X, Lu H, et al... (2012) Early results of a modified splenic hilar lymphadenectomy in laparoscopy-assisted total gastrectomy for gastric cancer with stage cT1-2: a case-control study. Surg Endosc.
    1. Lee MS, Lee JH, Park DJ, Lee HJ, Kim HH, et al... (2013) Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc.
    1. Kim HS, Kim BS, Lee IS, Lee S, Yook JH (2013) Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 23: 323–331.
    1. Bo T, Peiwu Y, Feng Q, Yongliang Z, Yan S, et al. (2013) Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study. J Gastrointest Surg 17: 1202–1208.
    1. Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, et al. (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years' experience. Surgery 137: 317–322.
    1. Memon MA, Khan S, Yunus RM, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 22: 1781–1789.
    1. Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, et al. (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15: 1625–1631.
    1. Lee SE, Kim YW, Lee JH, Ryu KW, Cho SJ, et al. (2009) Developing an institutional protocol guideline for laparoscopy-assisted distal gastrectomy. Ann Surg Oncol 16: 2231–2236.
    1. Griffin SM (2005) Gastric cancer in the East: same disease, different patient. Br J Surg 92: 1055–1056.
    1. Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, et al. (2005) Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 92: 1103–1109.
    1. Lee JH, Paik YH, Lee JS, Ryu KW, Kim CG, et al. (2007) Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol 14: 1288–1294.
    1. Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, et al. (2009) Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center. Arch Surg 144: 351–358 discussion 358.
    1. Kim MC, Jung GJ, Kim HH (2005) Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11: 7508–7511.
    1. Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, et al. (2007) Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 21: 28–33.
    1. Kunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, et al. (2008) Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech 18: 236–241.
    1. Fujiwara M, Kodera Y, Miura S, Kanyama Y, Yokoyama H, et al. (2005) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol 91: 26–32.
    1. Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, et al. (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135: 806–810.
    1. Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, et al. (2010) A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg 14: 958–964.
    1. Spence RK, Carson JA, Poses R, McCoy S, Pello M, et al. (1990) Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality. Am J Surg 159(3): 320–4.
    1. Wu WC, Smith TS, Henderson WG, Eaton CB, Poses RM, et al. (2010) Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg 252(1): 11–7.
    1. de Manzoni G, Verlato G, Roviello F, Morgagni P, Di Leo A, et al. (2002) The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients. Br J Cancer 87: 171–174.
    1. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, et al. (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340: 908–914.
    1. Hartgrink HH, van de Velde CJ, Putter H, Songun I, Tesselaar ME, et al. (2004) Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 30: 643–649.
    1. Danielson H, Kokkola A, Kiviluoto T, Siren J, Louhimo J, et al. (2007) Clinical outcome after D1 vs D2-3 gastrectomy for treatment of gastric cancer. Scand J Surg 96: 35–40.
    1. Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T (1989) Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 210: 596–602.
    1. Noguchi Y, Imada T, Matsumoto A, Coit DG, Brennan MF (1989) Radical surgery for gastric cancer. A review of the Japanese experience. Cancer 64: 2053–2062.
    1. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, et al. (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 79: 1522–1530.
    1. Degiuli M, Sasako M, Ponti A (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97: 643–649.
    1. Sierra A, Regueira FM, Hernandez-Lizoain JL, Pardo F, Martinez-Gonzalez MA, et al. (2003) Role of the extended lymphadenectomy in gastric cancer surgery: experience in a single institution. Ann Surg Oncol 10: 219–226.
    1. Enzinger PC, Benedetti JK, Meyerhardt JA, McCoy S, Hundahl SA, et al. (2007) Impact of hospital volume on recurrence and survival after surgery for gastric cancer. Ann Surg 245: 426–434.
    1. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11: 439–449.
    1. Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, et al. (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144: 1138–1142.
    1. Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, et al. (2002) A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 131: 401–407.
    1. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, et al. (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22: 2069–2077.
    1. Yu W, Choi GS, Chung HY (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93: 559–563.
    1. McCulloch P (2006) The role of surgery in patients with advanced gastric cancer. Best Pract Res Clin Gastroenterol 20: 767–787.

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