Laparoscopic Versus Open Gastrectomy for Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials.

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopy-assisted gastrectomy (LAG) is established for early gastric cancer.
• The efficacy and safety of LAG versus open gastrectomy (OG) for advanced gastric cancer (AGC) are not well-defined.

Purpose of the Study:

• To compare the efficacy and safety of LAG versus OG in patients with AGC.
• To provide evidence-based recommendations for surgical treatment of AGC.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane Library for relevant RCTs.
• Meta-analysis of pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI).
• Statistical analyses performed using R software with a random-effects model.

Main Results:

• Nine RCTs involving 3827 patients were analyzed.
• LAG demonstrated shorter hospital stays and reduced blood loss but longer operative times and a higher risk of pancreatic fistula.
• No significant differences were observed in intraoperative complications, lymph node retrieval, mortality, or long-term survival rates (3 and 5 years).

Conclusions:

• Laparoscopy-assisted gastrectomy (LAG) is a potentially effective and safe alternative to open gastrectomy (OG) for advanced gastric cancer (AGC).
• Increased vigilance for pancreatic fistula is warranted with LAG.
• Both LAG and OG offer comparable long-term oncological outcomes.