Laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a systematic review

Review of the literature collecting trials comparing laparoscopic (LGD2) and open D2 gastrectomies (OGD2) for the treatment of advanced gastric cancer (AGC).

Randomized control trials (RCTs) and non-RCTs comparing LGD2 with OGD2 for AGC treatment, published between 1 January 2000 to 30 November 2017 were identified by searching the PubMed, EMBASE and Cochrane Library databases. Primary endpoints included operative outcomes (operative time, intraoperative blood loss, number of transfused patients and conversion rates), postoperative outcomes (postoperative analgesic consumption, time to first ambulation, time to first flatus, time to first oral intake, length of postoperative hospital stay, postoperative morbidity, incidence of reoperation and postoperative in-hospital mortality), and oncologic outcomes (number of harvested lymph nodes, tumor recurrence, disease-free rates and overall survival rates). The modified Newcastle-Ottawa scale was used to assess the quality of RCTs and non-RCTs in the study.

Two RCT and 10 non-RCTs with a total of 2732 patients were included in the review. LGD2 when compared to OGD2 demonstrated significant lower intraoperative blood loss, shorter duration of analgesic administration, shorter times to first ambulation, flatus and oral intake, shorter postoperative hospital stay, lower incidence of nonsurgical complications. No significant differences were observed between LGD2 and OGD2 for the following criteria: postoperative in-hospital mortality, number of harvested lymph nodes, tumor recurrence, 5-year disease-free survival rates and five- or three-year overall survival rates. However, LGD2 had longer operative times.

Although a technically demanding and time-consuming procedure, LGD2 offers the advantages of minimal invasion and can achieve the same degree of radical resections, harvested lymph nodes and short- or long-term prognosis for the treatment of locally AGC.