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Updated: Jul 28, 2025
Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
Published on: December 27, 2024
Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of
Matthew G Davey1, Hugo C Temperley2, Niall J O'Sullivan3
1Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Republic of Ireland. matthewdavey21@rcsi.com.
Background And Objectives:
Optimal surgical management for gastric cancer remains controversial. We aimed to perform a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing outcomes after open gastrectomy (OG), laparoscopic-assisted gastrectomy (LAG), and robotic gastrectomy (RG) for gastric cancer.
Methods:
A systematic search of electronic databases was undertaken. An NMA was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using R and Shiny.
Results:
Twenty-two RCTs including 6890 patients were included. Overall, 49.6% of patients underwent LAG (3420/6890), 46.6% underwent OG (3212/6890), and 3.7% underwent RG (258/6890). At NMA, there was a no significant difference in recurrence rates following LAG (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.77-1.49) compared with OG. Similarly, overall survival (OS) outcomes were identical following OG and LAG (OS: OG, 87.0% [1652/1898] vs. LAG: OG, 87.0% [1650/1896]), with no differences in OS in meta-analysis (OR 1.02, 95% CI 0.77-1.52). Importantly, patients undergoing LAG experienced reduced intraoperative blood loss, surgical incisions, distance from proximal margins, postoperative hospital stays, and morbidity post-resection.
Conclusions:
LAG was associated with non-inferior oncological and surgical outcomes compared with OG. Surgical outcomes following LAG and RG superseded OG, with similar outcomes observed for both LAG and RG. Given these findings, minimally invasive approaches should be considered for the resection of local gastric cancer, once surgeon and institutional expertise allows.
Insights
Laparoscopic-assisted gastrectomy (LAG) offers comparable oncological outcomes to open gastrectomy (OG) for gastric cancer. LAG also demonstrates improved surgical results, including less blood loss and shorter hospital stays, supporting its use in local gastric cancer resection.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Optimal surgical management for gastric cancer is debated.
- This study compares open gastrectomy (OG), laparoscopic-assisted gastrectomy (LAG), and robotic gastrectomy (RG).
Approach:
- A network meta-analysis (NMA) of 22 randomized clinical trials (RCTs) involving 6890 patients was conducted.
- Data were analyzed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines.
Key Points:
- No significant difference in recurrence rates between LAG and OG.
- Overall survival (OS) outcomes were identical for OG and LAG.
- LAG patients showed reduced blood loss, shorter incisions, smaller margin distances, and decreased postoperative morbidity and hospital stays.
Conclusions:
- Laparoscopic-assisted gastrectomy (LAG) provides non-inferior oncological and superior surgical outcomes compared to open gastrectomy (OG).
- Both LAG and robotic gastrectomy (RG) offer better surgical outcomes than OG.
- Minimally invasive approaches like LAG are recommended for local gastric cancer resection when expertise is available.
