Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep;30(9):5544-5557.
doi: 10.1245/s10434-023-13654-6. Epub 2023 Jun 1.

Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

Matthew G Davey  1 , Hugo C Temperley  2 , Niall J O'Sullivan  3 , Vianka Marcelino  4 , Odhrán K Ryan  4 , Éanna J Ryan  5   4 , Noel E Donlon  5   6 , Sean M Johnston  7 , William B Robb  6
Affiliations

Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

Matthew G Davey et al. Ann Surg Oncol. 2023 Sep.

Abstract

Background and objectives: Optimal surgical management for gastric cancer remains controversial. We aimed to perform a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing outcomes after open gastrectomy (OG), laparoscopic-assisted gastrectomy (LAG), and robotic gastrectomy (RG) for gastric cancer.

Methods: A systematic search of electronic databases was undertaken. An NMA was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using R and Shiny.

Results: Twenty-two RCTs including 6890 patients were included. Overall, 49.6% of patients underwent LAG (3420/6890), 46.6% underwent OG (3212/6890), and 3.7% underwent RG (258/6890). At NMA, there was a no significant difference in recurrence rates following LAG (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.77-1.49) compared with OG. Similarly, overall survival (OS) outcomes were identical following OG and LAG (OS: OG, 87.0% [1652/1898] vs. LAG: OG, 87.0% [1650/1896]), with no differences in OS in meta-analysis (OR 1.02, 95% CI 0.77-1.52). Importantly, patients undergoing LAG experienced reduced intraoperative blood loss, surgical incisions, distance from proximal margins, postoperative hospital stays, and morbidity post-resection.

Conclusions: LAG was associated with non-inferior oncological and surgical outcomes compared with OG. Surgical outcomes following LAG and RG superseded OG, with similar outcomes observed for both LAG and RG. Given these findings, minimally invasive approaches should be considered for the resection of local gastric cancer, once surgeon and institutional expertise allows.

Keywords: Gastrectomy; Gastric cancer; Minimally invasive surgery; Oncological outcomes; Surgical oncology.

PubMed Disclaimer

Conflict of interest statement

Matthew G. Davey, Hugo C. Temperley, Niall J. O’Sullivan, Vianka Marcelino, Odhrán K. Ryan, Éanna J. Ryan, Noel E. Donlon, Sean M. Johnston, and William B. Robb have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
PRISMA flowchart outlining the systematic search process. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses, RCTs randomized controlled trials
Fig. 2
Fig. 2
Forest and network plots with respect to (a) disease recurrence and (b) overall survival
Fig. 3
Fig. 3
Forest and network plots with respect to intraoperative data. (a) Intraoperative time; (b) intraoperative blood loss; (c) lymph node harvest; (d) distance from the proximal margin; (e) distance from the distal margin; and (f) length of incision
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. - PubMed
    1. Wagner AD, Syn NL, Moehler M, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev. 2017;8:4CD004064. - PMC - PubMed
    1. Ng SP, Leong T. Role of radiation therapy in gastric cancer. Ann Surg Oncol. 2021;28(8):4151–4157. - PubMed
    1. Donlon NE, Davern M, Hayes C, et al. The immune response to major gastrointestinal cancer surgery and potential implications for adjuvant immunotherapy. Crit Rev Oncol Hematol. 2022;175:103729. - PubMed
    1. Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(Suppl 5):v38–v49. - PubMed

Publication types