Laparoscopy versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis

Laparoscopy-assisted distal gastrectomy (LADG) is one of the most accepted laparoscopic procedures in the field of gastric surgery. However, currently this procedure for the advanced gastric cancer (AGC) has still not reached the area of the popularization. The aim of this study was to compare laparoscopy with open distal gastrectomy in AGC patients using the meta-analytical techniques.

The Medline Ovid, PubMed, Cochrane Library, and the Controlled Trials Registry were electronically searched. Randomized controlled trails and retrospective case-control studies, which were published between 2001 and 2011 on the management of AGC were collected on the basis of the predetermined eligibility criteria to establish a literature database. Meta-analysis was performed using RevMan 5.0 software (Cochrane Library).

There were no randomized controlled trails available online; 7 case-control studies involving 1271 patients, of which 626 (49.2%) were laparoscopic and 645 (50.3%) were open procedures, were included in final pooled analysis. Meta-analysis results showed that LADG patients had a longer operative time [mean difference (MD), 37.2; 95% confidence interval (CI), 19.92 to 54.72, P < 0.0001] but a less estimated blood loss (MD, 122.94; 95% CI, -171.13 to -74.75; P < 0.0001), a few analgesic requirement (MD, 1.62; 95% CI, -2.51 to -0.73; P = 0.004), and a shorter hospital stay (MD, 3; 95% CI, -3.14 to -2.26; P < 0.00001) compared with patients undergoing open distal gastrectomy. There were no significant differences between the 2 groups in number of lymph node dissections (MD, -0.73; 95% CI, -3.04 to 1.57; P = 0.53), postoperative mortality [odds ratio (OR), 0.80; 95% CI, 0.14 to 4.73; P = 0.81], overall complications (OR, 1.24; 95% CI, 0.53 to 2.91; P = 0.62), and a 3-year overall survival rate (OR, 1.21; 95% CI, 0.92 to 1.60; P = 0.18).

The oncologic outcomes of LADG for AGC patients were comparable with open approach. Although open distal gastrectomy may be associated with shorter operative time, patients undergoing laparoscopic approach may be benefitted from a shorter hospital stay and a faster resumption without translation into an increase in both postoperative morbidity and mortality. Nevertheless, further prospective, controlled studies, and extended follow-up are needed for a more comprehensive comparison between the 2 procedures.