Systematic Review and Meta-analysis of Laparoscopic Versus Open Distal Gastrectomy
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Laparoscopic distal gastrectomy has been increasingly utilized in the treatment of gastric adenocarcinoma. This study aims to compare the morbidity/mortality and postoperative outcomes of laparoscopic-assisted versus open distal gastrectomy since 2000.
A comprehensive search of MEDLINE and EMBASE was conducted including studies published between 2000 and present.
Seventeen studies with a total of 7,109 distal gastrectomies (3,496 lap vs 3,613 open) were included. Across all studies, postoperative morbidity rates for laparoscopic gastrectomy were lower than that of open [median (range) 10 (0–36) % vs 17 (0–43) %]. Meta-analysis of postoperative morbidity rates in prospective studies only yielded pooled odds ratio of 0.52 (95 % CI 0.33–0.81) (P = 0.004). In-hospital mortality rates were comparable between the two (range: laparoscopic 0–3.3 vs open 0–6.7 %). The long-term oncological outcomes of resection were difficult to analyze given variable reporting but appeared similar between the two. Meta-analysis of prospective studies showed that laparoscopic-assisted distal gastrectomy was associated with significantly shorter hospital length of stay [standard mean difference (SMD) = −0.78 (95 % CI = −1.0 to −0.56)], comparable intraoperative bleeding [SMD = 0.64 (95 % CI = −1.3–0.0430) P = 0.066] and longer operative time compared to open gastrectomy [1.9 (95 % CI 0.05–3.8) P = 0.045, with P < 0.001].
This study supports the use of laparoscopic-assisted distal gastrectomy for treatment of gastric adenocarcinoma with evidence of comparable, if not better, short-term postoperative parameters when compared to open distal gastrectomy. The long-term oncological outcomes appear similar but may require more evaluation.
KeywordsLaparoscopic distal gastrectomy Open distal gastrectomy Gastric cancer Meta-analysis Post-op complications Mortality
Conflict of Interest
The authors of this paper (QC, TP, MH, AR, HP, EJ, and VL) do not have any conflict of interest between this research paper and an existing commercial part.
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