Related Experiment Video
Updated: Jun 26, 2025
Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
Published on: December 27, 2024
Short-Term Outcomes Analysis Comparing Open, Laparoscopic, Laparoscopic-Assisted, and Robotic Distal Gastrectomy for
Michele Manara1, Alberto Aiolfi1, Andrea Sozzi1
1I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy.
Background:
Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer.
Methods:
Systematic review and randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG), laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size measures were the risk ratio (RR), the weighted mean difference (WMD), and the 95% credible intervals (CrIs).
Results:
Ten RCTs (3823 patients) were included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG, 1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe complications (Clavien-Dindo > 3), and in-hospital mortality were comparable. No differences were observed for reoperation rate, pulmonary complications, postoperative bleeding requiring transfusion, surgical-site infection, cardiovascular complications, number of harvested lymph nodes, and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG showed a significantly reduced intraoperative blood loss with a trend toward shorter time to first flatus and reduced length of stay.
Conclusions:
LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by dedicated surgeons have comparable short-term outcomes to Op-DG for locally AGC.
Insights
Minimally invasive distal gastrectomy (LapAs-DG, Lap-DG, Rob-DG) offers comparable short-term outcomes to open distal gastrectomy (Op-DG) for advanced gastric cancer. These advanced surgical approaches show similar complication rates and survival benefits.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- The optimal surgical approach for locally advanced gastric cancer (AGC) remains a subject of debate.
- Minimally invasive techniques are increasingly explored for gastric cancer treatment.
Purpose of the Study:
- To comprehensively assess and compare the principal surgical treatments for resectable distal gastric cancer.
- Evaluate the short-term outcomes of open, laparoscopic-assisted, totally laparoscopic, and robotic distal gastrectomy.
Main Methods:
- Systematic review and randomized controlled trials (RCTs) network meta-analysis.
- Comparison of open distal gastrectomy (Op-DG), laparoscopic-assisted distal gastrectomy (LapAs-DG), totally laparoscopic distal gastrectomy (Lap-DG), and robotic distal gastrectomy (Rob-DG).
- Pooled effect-size measures included risk ratio (RR) and weighted mean difference (WMD) with 95% credible intervals (CrIs).
Main Results:
- Ten RCTs involving 3823 patients were analyzed.
- Anastomotic leak, severe complications (Clavien-Dindo > 3), and in-hospital mortality were comparable across all groups.
- Laparoscopic approaches (Lap-DG, LapAs-DG) demonstrated significantly reduced intraoperative blood loss compared to Op-DG, with trends toward faster recovery (flatus, shorter hospital stay).
Conclusions:
- Minimally invasive distal gastrectomy (LapAs-DG, Lap-DG, Rob-DG) performed in specialized centers by experienced surgeons yields comparable short-term outcomes to open distal gastrectomy (Op-DG) for locally advanced gastric cancer.
- No significant differences were observed in oncological outcomes like harvested lymph nodes or tumor-free resection margins.
