Totally laparoscopic verse laparoscopic assisted distal gastrostomy for gastric cancer: an update meta-analysis

Totally laparoscopic distal gastrostomy (TLDG) and laparoscopic- assisted distal gastrostomy (LADG) are the minimally invasive surgical technology for gastric cancer. This study aimed to compare the surgical outcomes of these two methods. Relevant studies were selected through electronic searches of EMBASE, PubMed and Web of Science. In total, 21 non-randomized controlled studies containing 2475 patients in the totally laparoscopic distal gastrostomy and 1889 patients in the laparoscopic-assisted distal gastrostomy were included in this study. And operative time, operative blood loss, retrieved lymph nodes, time to liquid diet (days), postoperative hospital stay and overall complications were pooled and compared using meta-analysis. There were no significant differences between operative time (WMD = 0.38, 95% CI -10.43 -11.18, P = 0.95) and overall complications (RR = 1.09, 95% CI 0.91-1.30, P = 0.36). But totally laparoscopic distal gastrostomy had more advantages in aspects of intraoperative blood loss (WMD = 24.4, 95% CI 12.45-36.36, P < 0.0001), time to liquid diet (days) (WMD = 0.21, 95% CI 0.03-0.40, P = 0.03) and postoperative hospital stay (WMD = 0.72, 95% CI 0.31-1.13, P = 0.0006). Moreover, totally laparoscopic distal gastrostomy had more retrieved lymph nodes (WMD = -1.24, 95% CI-1.90 to-0.58, P = 0.0002). This meta-analysis indicates that totally laparoscopic distal gastrostomy may be a safe, feasible, and favorable surgical technology in terms of less blood loss, faster liquid diet, shorter postoperative hospital stay and more lymph nodes retrieved.