Laparoscopic gastrectomy for advanced gastric cancer: are the long-term results comparable with conventional open gastrectomy? A systematic review and meta-analysis

Abstract

Background and objective: Laparoscopic gastrectomy (LG) for gastric cancer has been adopted to treat both early and locally advanced gastric cancer (AGC), but there are still concerns about its oncologic safety especially in AGC. The purpose of this meta-analysis is to compare the long-term outcomes of LG with those of open gastrectomy (OG) in patients with AGC.

Methods: The quantitative synthesis of outcomes of studies from three major databases, PubMed, Embase, and the Cochrane Central, was performed using common keywords related to gastric cancer and laparoscopy on July 31, 2012.

Results: Ten studies (one randomized controlled trial and nine retrospective cohort studies) with 1,819 participants (960 patients in OG, and 859 patients in LG) were included in the current meta-analysis. Nine studies compared the overall survival rate between LG and OG for AGC, and five studies reported the disease-free survival. There was no statistical difference in overall survival (hazard ratio [HR]: 0.90, 95% confidence interval [CI]: 0.76-1.06, P = 0.22) and disease-free survival (HR: 1.03, 95% CI: 0.76-1.40, P = 0.86) between the two modalities.

Conclusions: The current clinical evidence revealed that there was no evidence that LG is inferior to OG even for AGC if the surgeons have sufficient experience.

Keywords: gastric cancer; laparoscopy; meta-analysis; minimally invasive surgery; prognosis.