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Laparoscopic Versus Open Gastrectomy for Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials

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Abstract

Background

Laparoscopy-assisted gastrectomy (LAG) is a well-established surgical technique in treating patients with early gastric cancer. However, the efficacy and safety of LAG versus open gastrectomy (OG) in patients with advanced gastric cancer (AGC) remains unclear.

Methods

We systematically searched PubMed, Embase, and Cochrane Library in June 2023 for RCTs comparing LAG versus OG in patients with AGC. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous endpoints, respectively. We performed all statistical analyses using R software version 4.3.1 and a random-effects model.

Results

Nine RCTs comprising 3827 patients were included. There were no differences in terms of intraoperative complications (RR 1.14; 95% CI 0.72 to 1.82), number of retrieved lymph nodes (MD −0.54 lymph nodes; 95% CI −1.18 to 0.09), or mortality (RR 0.91; 95% CI 0.30 to 2.83). LAG was associated with a longer operative time (MD 49.28 minutes; 95% CI 30.88 to 67.69), lower intraoperative blood loss (MD −51.24 milliliters; 95% CI −81.41 to −21.06), shorter length of stay (MD −0.83 days; 95% CI −1.60 to −0.06), and higher incidence of pancreatic fistula (RR 2.44; 95% CI 1.08 to 5.50). Postoperatively, LAG was also superior to OG in reducing bleeding rates (RR 0.44; 95% CI 0.22 to 0.86) and time to first flatus (MD −0.27 days; 95% CI −0.47 to −0.07), with comparable results in anastomotic leakage, wound healing issues, major complications, time to ambulation, or time to first liquid intake. In the long-term analyses at 3 and 5 years, there were no significant differences between LAG and OG in terms of overall survival (RR 0.99; 95% CI 0.96 to 1.03) or relapse-free survival (RR 0.99; 95% CI 0.94 to 1.04).

Conclusion

This meta-analysis of RCTs suggests that LAG may be an effective and safe alternative to OG for treating AGC; albeit, it may be associated with an increased risk for pancreatic fistula.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

AGC:

Advanced gastric cancer

CI:

Confidence interval

EGC:

Early gastric cancer

ICU:

Intensive care unit

LAG:

Laparoscopic-assisted gastrectomy

OG:

Open gastrectomy

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

PROSPERO:

International Prospective Register of Systematic Reviews

RCT:

Randomized controlled trial

RR:

Risk ratio

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Acknowledgements

We acknowledge the methodological support by Professor Carlos Augusto Moreira de Sousa, graduated in Statistics with a PhD in epidemiology in Public Health; and by Professor Lincoln Faria da Silva, graduated in Mathematics with a PhD in Computing Science, who have extensive expertise in meta-analysis statistics.

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Authors and Affiliations

  1. Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil

    Vinicius Bittar, Mauricio Ferreira Boneli, Leonardo O. Fogaroli, Gamaliel B. Costa, Gustavo Amaral & Danyelle Cristine Marini

  2. Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Pedro C. Abrahão Reis & Marcelo Antonio Pinheiro Braga

  3. Universidade Federal de Campina Grande, Campina Grande, Brazil

    Nicole Felix

  4. Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

    Kian M. Rocha

  5. A. C. Camargo Cancer Center, São Paulo, Brazil

    Ana Carolina Comini & Marcos P. G. Camandaroba

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  1. Vinicius Bittar
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Contributions

V.B. and M.F.B. planned, conducted, collected, and drafted the study. P.C.A.R. conducted, collected, and performed statistical analysis. M.A.P.B and K.M.R. contributed to analyzing the manuscript data and conducting the risk of bias. L.O.F. and G.B.C. contributed to analyzing and collecting the manuscript data. A.C.C., G.A., D.C.M. reviewed it critically for important intellectual content and contributed to interpretation of data. N.F. and M.P.G.C. contributed to conducting, reviewing critically, and interpreting the manuscript data.

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Correspondence to Vinicius Bittar.

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Bittar, V., Boneli, M.F., Reis, P.C.A. et al. Laparoscopic Versus Open Gastrectomy for Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials. J Gastrointest Canc (2024). https://doi.org/10.1007/s12029-024-01048-0

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