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Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis

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Abstract

Background

Laparoscopic proximal gastrectomy (LPG) is regarded as a less invasive surgery than laparoscopic total gastrectomy (LTG) for early gastric cancer located on the proximal side of the stomach. However, whether LPG is more effective than LTG remains unclear.

Methods

A systematic literature search of studies assessing short-term surgical and nutritional outcomes after LPG and LTG was conducted. A meta-analysis of surgical outcomes (operative time, intraoperative estimated blood loss, postoperative complications, and length of hospital stay) and nutritional outcomes (decrease in body weight, albumin, hemoglobin, total protein, and lymphocyte count) was then performed. All of 11 papers are a retrospective cohort study.

Results

Eleven studies reported assessments of the above-mentioned outcomes in 883 patients. There was a trend towards shorter operative time and lower blood loss for LPG compared to LTG though not reaching statistical significance. Other surgical outcomes showed no significant differences. Patients who underwent LTG had a significantly lower body weight (95% confidence interval, 3.01–6.05, \(\bar{-}{x} \) = 4.53, p < 0.01) and hemoglobin level (95% confidence interval, 1.88–5.87, \( \bar{-}{x}\) = 3.87, p < 0.01) than patients who underwent LPG at 1 year after surgery. There were no significant differences in other nutritional outcomes.

Conclusions

These results indicate LPG had some advantages in postoperative nutrition. However, no significant differences in short-term surgical outcomes were noted between the two operations. Our analysis suggests that LPG may be more beneficial compared with LTG in terms of perioperative and nutritional outcomes for early-stage gastric cancer.

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Funding

The authors have received no grant support or other forms of assistance.

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Authors and Affiliations

  1. Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Toshiro Tanioka, Ryosuke Fukuyo, Toshifumi Saito, Yuya Umebayashi, Emi Kanemoto, Kenta Kobayashi, Masatoshi Nakagawa & Mikito Inokuchi

  2. Division of General Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

    Rawat Waratchanont

Authors
  1. Toshiro Tanioka
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  2. Rawat Waratchanont
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  3. Ryosuke Fukuyo
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  4. Toshifumi Saito
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  5. Yuya Umebayashi
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Correspondence to Toshiro Tanioka.

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Disclosures

Drs. Toshiro Tanioka, Rawat Waratchanont, Ryosuke Fukuyo, Toshifumi Saito, Yuya Umebayashi, Emi Kanemoto, Kenta Kobayashi, Masatoshi Nakagawa, and Mikito Inokuchi have no conflicts of interest or financial ties to disclose.

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Tanioka, T., Waratchanont, R., Fukuyo, R. et al. Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis. Surg Endosc 34, 1061–1069 (2020). https://doi.org/10.1007/s00464-019-07352-2

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