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Meta-Analysis
. 2024 Feb 1;110(2):1245-1265.
doi: 10.1097/JS9.0000000000000921.

Safety and effectiveness of totally laparoscopic total gastrectomy vs laparoscopic-assisted total gastrectomy: a meta-analysis

Qishuan Wu  1 , Yan Wang  2 , Qifan Peng  2 , Mingshuai Bai  2 , Zhou Shang  1 , Leping Li  1   2 , Feng Tian  1   2 , Changqing Jing  1   2
Affiliations
Meta-Analysis

Safety and effectiveness of totally laparoscopic total gastrectomy vs laparoscopic-assisted total gastrectomy: a meta-analysis

Qishuan Wu et al. Int J Surg. .

Abstract

Background: For gastric cancer with total gastrectomy, the usual laparoscopic surgical approaches are totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG). Due to its difficult anastomotic technique, the adoption of TLTG is limited. Therefore, surgeons prefer using LATG, which also led to TLTG being somewhat overlooked, so there is no clear conclusion today as to which surgical procedure is more favorable to the patient's recovery. This article aimed to compare the safety and short-term outcomes of the two surgical approaches.

Materials and methods: Studies comparing TLTG and LATG, published up to December 2022, were searched in PubMed, Web of Science, and Embase databases. The study outcomes, including operative time, blood loss, anastomosis time, number of retrieved lymph nodes, proximal and distal resection margins, time to first fluid and soft diet, hospitalization duration, time to first flatus, and postsurgical and anastomotic complications, were compared between these two different surgical procedures. Statistics were analyzed with RevMan 5.4 and Stata 13.1.

Results: Fifteen publications were included in this study. The total sample included 3023 cases. The meta-analysis revealed no significant difference in overall postoperative complications between the two surgical approaches ( P >0.05). Compared with LATG, TLTG led to reduced intraoperative blood loss ( P <0.0001), an increased number of lymphatic node dissections ( P <0.0001), and decreased hospitalization duration ( P =0.002). However, operative time, anastomosis time, pulmonary infection, resection margins, time to first fluid and soft diet, time to first flatus and anastomosis-related complications were no significant difference between TLTG and LATG groups ( P >0.05).

Conclusion: TLTG did not lead to an increase in overall postoperative complications, which is a reliable surgical approach for treatment of gastric cancer. Moreover, it may reduce harm to patients and enable them to obtain better surgical outcomes.

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Conflict of interest statement

The authors promise that this research has no conflict of interest with any party.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flowchart for study retrieval.
Figure 2
Figure 2
Meta-analysis result of operative time. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 3
Figure 3
Meta-analysis result of intraoperative blood loss. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 4
Figure 4
Meta-analysis results of the number of lymph nodes removed. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 5
Figure 5
Meta-analysis results of the proximal resection margin. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 6
Figure 6
Meta-analysis results of the distal resection margin. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 7
Figure 7
Meta-analysis results of the anastomosis time. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 8
Figure 8
Meta-analysis results of the overall postoperative complications. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 9
Figure 9
Meta-analysis results of the anastomotic fistula. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 10
Figure 10
Meta-analysis results of the anastomotic stenosis. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 11
Figure 11
Meta-analysis results of the anastomotic bleeding. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 12
Figure 12
Meta-analysis results of the postoperative pulmonary infection. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 13
Figure 13
Meta-analysis results of the postoperative hospital duration. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 14
Figure 14
Meta-analysis results of the time to first flatus. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 15
Figure 15
Meta-analysis results of the time to first liquid diet. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 16
Figure 16
Meta-analysis results of the time to soft diet. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 17
Figure 17
Subgroup analysis results of the overall postoperative complications stratified by stapler type. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 18
Figure 18
Subgroup analysis results of the anastomotic fistula stratified by stapler type. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 19
Figure 19
Subgroup analysis results of the anastomotic stenosis stratified by stapler type. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 20
Figure 20
Subgroup analysis results of the postoperative pulmonary infection stratified by stapler type. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 21
Figure 21
Subgroup analysis results of the number of lymph nodes removed stratified by stapler type. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 22
Figure 22
Subgroup analysis results of the blood loss stratified by stapler type. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 23
Figure 23
Subgroup analysis results of the overall postoperative complications stratified by neoadjuvant therapy. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 24
Figure 24
Subgroup analysis results of the anastomotic fistula stratified by neoadjuvant therapy. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 25
Figure 25
Subgroup analysis results of the postoperative pulmonary infection stratified by neoadjuvant therapy. LATG, laparoscopic-assisted total gastrectomy; TLTG, totally laparoscopic total gastrectomy.
Figure 26
Figure 26
Funnel plot of overall postoperative complications. RR, risk ratio; SE, standard error.
Figure 27
Figure 27
Egger’s publication bias plot of the overall postoperative complications.
Figure 28
Figure 28
Begg’s funnel plot of the overall postoperative complications.
Figure 29
Figure 29
Sensitivity analysis of overall postoperative complications.
Figure 30
Figure 30
Sensitivity analysis of the blood loss.
Figure 31
Figure 31
Sensitivity analysis of the operative time.
Figure 32
Figure 32
Sensitivity analysis of the anastomosis time.
Figure 33
Figure 33
Sensitivity analysis of the time to first flatus.
Figure 34
Figure 34
Sensitivity analysis of the proximal resection margin.
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