Journal of Gastrointestinal Surgery

, Volume 18, Issue 6, pp 1087–1099 | Cite as

Systematic Review and Meta-analysis of Laparoscopic Versus Open Distal Gastrectomy

  • Qiuye Cheng
  • Tony C. Y. Pang
  • Michael J. Hollands
  • Arthur J. Richardson
  • Henry Pleass
  • Emma S. Johnston
  • Vincent W. T. Lam
Original Article



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.


Laparoscopic 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.


  1. 1.
    Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World Journal of Gastroenterology 2005;11(47):7508-11.PubMedGoogle Scholar
  2. 2.
    Adachi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Annals of Surgery 1999;229(1): 49-54.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Shimizu S, Mizumoto K, Morisaki T, Nakamura K, Shimura H, Tanaka M. Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surgical Endoscopy 2000;14:27-31.PubMedCrossRefGoogle Scholar
  4. 4.
    Yano H, Monden T, Kinuta M, Nakano Y, Tono T, Matsui S, Iwazawa T, Kanoh T, Katsushima S. The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 2001;4(2):93-7.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Annals of Surgery 2010;251(3): 417-20.PubMedCrossRefGoogle Scholar
  6. 6.
    Harris R, Bradburn M, Deeks J, Harbord R, Altman D, Sterne J..Metan: fixed- and random-effects meta-analysis. The Stata Journal, 2008;8(1):3-28.Google Scholar
  7. 7.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic Versus Open Subtotal Gastrectomy for Distal Gastric Cancer. Annals of Surgery 2005;241(2):232-237. 18PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kim, YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Annals of Surgery 2008;248(5): 721-7.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee JH,.Han HS. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surgical Endoscopy 2005;19(2):168-73.PubMedCrossRefGoogle Scholar
  10. 10.
    Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case-control study. Annals of Surgical Oncology 2009;16(6):1507-13.PubMedCrossRefGoogle Scholar
  11. 11.
    Takiguchi S, Fujiwara Y, Yamasaki M, Miyata H, Nakajima K, Sekimoto M, Mori M, Doki Y. Laparoscopy-Assisted Distal Gastrectomy Versus Open Distal Gastrectomy. A Prospective Randomized Single-Blind Study. World Journal of Surgery 2013;37(10):2379-2386.PubMedCrossRefGoogle Scholar
  12. 12.
    Adachi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-Assisted Billroth I Gastrectomy Compared With Conventional Open Gastrectomy. Archives of Surgery 2000;135(7):806-810.PubMedCrossRefGoogle Scholar
  13. 13.
    Huang JL, Wei HB, Zheng ZH, Wei B, Chen TF, Huang Y, Guo WP, Hu BG. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer. Digestive Surgery 2010;27(4):291-6.PubMedCrossRefGoogle Scholar
  14. 14.
    Ikeguchi M, Hatada T, Yamamoto M, Miyake T, Matsunaga T, Fukuda K, Saito H, Tatebe S. Evaluation of a pylorus-preserving gastrectomy for patients 19 preoperatively diagnosed with early gastric cancer located in the middle third of the stomach. Surgery Today 2010;40(3):228-33PubMedCrossRefGoogle Scholar
  15. 15.
    Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surgical Endoscopy 2008;22(5):1161-4.PubMedCrossRefGoogle Scholar
  16. 16.
    Yasunaga H, Horiguchi H, Kuwabara S, Matsuda S, Fushimi K, Hashimoto H, Ayanian JZ. Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer: a propensity-matched analysis. Annals of Surgery 2013;257(4):640-6.PubMedCrossRefGoogle Scholar
  17. 17.
    Orsenigo E, Di Palo S, Tamburini A, Staudacher C. Laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a monoinstitutional Western center experience. Surgical Endoscopy 2010;25(1):140-5.PubMedCrossRefGoogle Scholar
  18. 18.
    Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, Kuwano H. Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years' experience. Surgery 2005;137 (3):317-322.PubMedCrossRefGoogle Scholar
  19. 19.
    Kawamura H, Okada K, Isizu H, Masuko H, Yamagami H, Honma S, Ueki S, Noguchi K, Kondo Y. Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure. Surgical Endoscopy 2008;22(1):81-5.PubMedCrossRefGoogle Scholar
  20. 20.
    Du XH, Li R, Chen L, Shen D, Li SY, Guo Q. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer: initial experience. Chinese Medical Journal 2009;122(12):1404-7. 20PubMedGoogle Scholar
  21. 21.
    Han JH, Lee HJ, Suh YS, Han DS, Kong SH, Yang HK. Laparoscopy-assisted distal gastrectomy compared to open distal gastrectomy in early gastric cancer. Digestive Surgery 2011;28(4):245-51.PubMedCrossRefGoogle Scholar
  22. 22.
    Ziqiang W, Feng Q, Zhimin C, Miao W, Lian Q, Huaxing L, Peiwu Y. Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Surgical Endoscopy 2006;20(11):1738-43.PubMedCrossRefGoogle Scholar
  23. 23.
    Ikenaga NNK, Iwashita T, Suehara N, Mitsuyama S. Long-term quality of life after laparoscopically assisted distal gastrectomy for gastric cancer. Journal of Laparoendoscopic and Advanced Surgical Techniques 2006. 16(2):199-123.CrossRefGoogle Scholar
  24. 24.
    Roukos DH. Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer. Annals of Surgical Oncology 1999;6(1):46-56.PubMedCrossRefGoogle Scholar
  25. 25.
    Zeng Y-K, Yang Z-L, Peng J-S, Lin H-S, Cai L. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Annals of Surgery 2012;256(1):39-52.PubMedCrossRefGoogle Scholar
  26. 26.
    Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, Kohler L, Barlehner E, Kocherling F. Importance of conversion for results obtained with laparoscopic colorectal surgery. Disease of Colon and Rectum 2001;44(2):207-14; discussion 214-6.CrossRefGoogle Scholar
  27. 27.
    Tokunaga M HN, Fukunaga T, Miki A, Ohyama S, Miyata S, Yamaguchi T. Learning curve of laparoscopy-assisted gastrectomy using a standardized surgical technique and an established educational system. Scandinavian Journal of Surgery 2011;100(2):86-91. 21Google Scholar
  28. 28.
    Wong DL, H. EM, Wilson D, Winkelstein ML, Schwartz P. Wong’s Essentials of Pediatric Nursing 6th ed. St.Louis: Mosby 2001.Google Scholar
  29. 29.
    Kunisaki C, Makino H, Kosaka T, Oshima T, Fujii S, Takagawa R, Kimura J, Ono HA, Akiyama H, Taguri M, Morita S, Endo I. Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study. Surgical Endoscopy 2012;26(3):804-10.PubMedCrossRefGoogle Scholar
  30. 30.
    Kobayashi DKY, Fujiwara M, Koike M, Nakayama G, Nakao A. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World Journal of Surgery 2011;35(2):357-364. 31.PubMedCrossRefGoogle Scholar
  31. 31.
    Shiraishi N, Adachi Y, Kitano S, Bandoh T, Katsuta T, Morimoto A. Indication for and outcome of laparoscopy-assisted Billroth I gastrectomy. British Journal of Surgery 1999;86(4):541-4.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Qiuye Cheng
    • 1
    • 2
  • Tony C. Y. Pang
    • 1
    • 2
  • Michael J. Hollands
    • 1
    • 2
  • Arthur J. Richardson
    • 1
    • 2
  • Henry Pleass
    • 1
    • 2
  • Emma S. Johnston
    • 1
    • 2
  • Vincent W. T. Lam
    • 1
    • 2
  1. 1.Department of SurgeryWestmead HospitalWentworthvilleAustralia
  2. 2.Discipline of SurgeryUniversity of SydneySydneyAustralia

Personalised recommendations