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Meta-Analysis
. 2020 Jun 13;18(1):126.
doi: 10.1186/s12957-020-01888-7.

Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review

Zhipeng Zhu  1 , Lulu Li  1 , Jiuhua Xu  2 , Weipeng Ye  2 , Junjie Zeng  1 , Borong Chen  1 , Zhengjie Huang  3   4
Affiliations
Meta-Analysis

Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review

Zhipeng Zhu et al. World J Surg Oncol. .

Abstract

Background: Additional studies comparing laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for advanced gastric cancer (AGC) have been published, and it is necessary to update the systematic review of this subject.

Objective: We conducted the meta-analysis to find some proof for the use of LG in AGC and evaluate whether LG is an alternative treatment for AGC.

Method: Randomized controlled trials (RCT) and high-quality retrospective studies (NRCT) compared LG and OG for AGC, which were published in English between January 2010 and May 2019, were search in PubMed, Embase, and Web of Knowledge by three authors independently and thoroughly. Some primary endpoints were compared between the two groups, including intraoperative time, intraoperative blood loss, harvested lymph nodes, first flatus, first oral intake, first out of bed, post-operative hospital stay, postoperative morbidity and mortality, rate of disease recurrence, and 5-year over survival (5-y OS). Besides, considering for this 10-year dramatical surgical material development between 2010 and 2019, we furtherly make the same analysis based on recent studies published between 2016 and 2019.

Result: Thirty-six studies were enrolled in this systematic review and meta-analysis, including 5714 cases in LAG and 6094 cases in OG. LG showed longer intraoperative time, less intraoperative blood loss, and quicker recovery after operations. The number of harvested lymph nodes, hospital mortality, and tumor recurrence were similar. Postoperative morbidity and 5-y OS favored LG. Furthermore, the systemic analysis of recent studies published between 2016 and 2019 revealed similar result.

Conclusion: A positive trend was indicated towards LG. LG can be performed as an alternative to OG for AGC.

Keywords: Advanced gastric cancer; Gastrectomy; Laparoscopy; Meta-analysis; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the meta-analysis
Fig. 2
Fig. 2
Forest plot of harvested lymph nodes
Fig. 3
Fig. 3
Forest plot of morbidity
Fig. 4
Fig. 4
Forest plot of 30-day mortality
Fig. 5
Fig. 5
Forest plot of 5-year overall survival
Fig. 6
Fig. 6
Forest plot tumor recurrence
See this image and copyright information in PMC

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