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Meta-Analysis
. 2006 Dec 21;12(47):7676-83.
doi: 10.3748/wjg.v12.i47.7676.

Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy

Shunsuke Hosono  1 , Yuichi Arimoto, Hiroshi Ohtani, Yoshitetsu Kanamiya
Affiliations
Meta-Analysis

Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy

Shunsuke Hosono et al. World J Gastroenterol. .

Abstract

Aim: To elucidate the current status of laparoscopy-assisted distal gastrectomy (LADG) with regard to its short-term outcomes by comparing it with conventional open distal gastrectomy (CODG).

Methods: Original articles published from January 1991 to August 2006 were searched in the MEDLINE, EMBASE, and Cochrane Controlled Trials Register. Clinical appraisal and data extraction were conducted independently by 2 reviewers. A meta-analysis was performed using a random effects model.

Results: Outcomes of 1611 procedures from 4 randomized controlled trials and 12 retrospective studies were analyzed. Compared to CODG, LADG was a longer procedure (weighted mean difference [WMD] 54.3; 95% confidence interval [CI] 38.8 to 69.8; P < 0.001), but was associated with a lower associated morbidity (odds ratio [OR] 0.54; 95% CI 0.37 to 0.77; P < 0.001); this was most significant for postoperative ileus (OR 0.27; 95% CI 0.09 to 0.84; P = 0.02). There was no significant difference between the two groups in anastomotic, pulmonary, and wound complications and mortality. Duration from surgery to first passage of flatus was faster (WMD -0.68; 95% CI -0.85 to -0.50; P < 0.001) and the frequency of additional analgesic requirement (WMD -1.36; 95% CI -2.44 to -0.28; P = 0.01), and duration of hospital stay (WMD -5.51; 95% CI -7.61 to -3.42; P < 0.001) were significantly lower after LADG. However, a significantly higher number of lymph nodes were dissected by CODG (WMD -4.35; 95% CI -5.73 to -2.98; P < 0.001).

Conclusion: LADG for early gastric cancer is associated with a lower morbidity, less pain, faster bowel function recovery, and shorter hospital stay.

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Figures

Figure 1
Figure 1
Analysis of the number of lymph nodes dissected. Weighted mean differences (WMDs) are shown with 95% CI.
Figure 2
Figure 2
Analysis of overall complications. Weighted mean differences (WMDs) are shown with 95% CI.
Figure 3
Figure 3
Analysis of postoperative ileus. Odds ratios (ORs) are shown with 95% CI.
Figure 4
Figure 4
Analysis of the number of days from surgery to the first passage of flatus. Weighted mean differences (WMDs) are shown with 95% CI.
See this image and copyright information in PMC

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