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Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer.

Chen K, Xu XW, Mou YP, Pan Y, Zhou YC, Zhang RC, Wu D - World J Surg Oncol (2013)

Bottom Line: Despite a longer operation, LG is a safe technical alternative to OG for AGC with a lower complication rate and enhanced postoperative recovery.Moreover, there were similar outcomes between both approaches in terms of cancer recurrence and the long-term survival rate.Because of the limitation of this study, methodologically high-quality studies are needed for further evaluation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province 310016, China.

ABSTRACT

Background: The use of laparoscopic gastrectomy (LG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. This study is a systematic review and meta-analysis of the available evidence.

Methods: A comprehensive search was performed until June 2013 to identify comparative studies evaluating survival rates, recurrence rates, surgical outcomes and complications. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using the random effects model. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.

Results: Fifteen trials were involved in this analysis. Compared to open gastrectomy (OG), LG involved a longer operating time (WMD = 48.67 min, 95% CI 34.09 to 63.26, P < 0.001); less blood loss (WMD = -139.01 ml, 95% CI -174.57 to -103.44, P < 0.001); earlier time to flatus (WMD = -0.79 days, 95% CI -1.14 to -0.44, P < 0.001); shorter hospital stay (WMD = -3.11 days, 95% CI -4.13 to -2.09, P < 0.001); and a decrease in complications (RR = 0.74, 95% CI 0.61 to 0.90, P = 0.003). There was no significant difference in the number of harvested lymph nodes, margin distance, mortality, cancer recurrence rate and long-term survival rate between the AGC patients treated with LG or OG (P > 0.05).

Conclusions: Despite a longer operation, LG is a safe technical alternative to OG for AGC with a lower complication rate and enhanced postoperative recovery. Moreover, there were similar outcomes between both approaches in terms of cancer recurrence and the long-term survival rate. Because of the limitation of this study, methodologically high-quality studies are needed for further evaluation.

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Related in: MedlinePlus

Flow chart of literature search strategies.
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Related In: Results  -  Collection

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Figure 1: Flow chart of literature search strategies.

Mentions: The initial search strategy retrieved 2,068 publications in English. After the titles and abstracts had been reviewed, papers without comparison of LG and OG for AGC were excluded, which left 21 comparative studies, 6 [25-30] of which did not meet the inclusion criteria and were excluded. This left a total of two RCTs and 13 observational studies [31-45], all of which were accessible in full-text format. A flow chart of the search strategies is illustrated in FigureĀ 1.


Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer.

Chen K, Xu XW, Mou YP, Pan Y, Zhou YC, Zhang RC, Wu D - World J Surg Oncol (2013)

Flow chart of literature search strategies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750547&req=5

Figure 1: Flow chart of literature search strategies.
Mentions: The initial search strategy retrieved 2,068 publications in English. After the titles and abstracts had been reviewed, papers without comparison of LG and OG for AGC were excluded, which left 21 comparative studies, 6 [25-30] of which did not meet the inclusion criteria and were excluded. This left a total of two RCTs and 13 observational studies [31-45], all of which were accessible in full-text format. A flow chart of the search strategies is illustrated in FigureĀ 1.

Bottom Line: Despite a longer operation, LG is a safe technical alternative to OG for AGC with a lower complication rate and enhanced postoperative recovery.Moreover, there were similar outcomes between both approaches in terms of cancer recurrence and the long-term survival rate.Because of the limitation of this study, methodologically high-quality studies are needed for further evaluation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province 310016, China.

ABSTRACT

Background: The use of laparoscopic gastrectomy (LG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. This study is a systematic review and meta-analysis of the available evidence.

Methods: A comprehensive search was performed until June 2013 to identify comparative studies evaluating survival rates, recurrence rates, surgical outcomes and complications. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using the random effects model. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.

Results: Fifteen trials were involved in this analysis. Compared to open gastrectomy (OG), LG involved a longer operating time (WMD = 48.67 min, 95% CI 34.09 to 63.26, P < 0.001); less blood loss (WMD = -139.01 ml, 95% CI -174.57 to -103.44, P < 0.001); earlier time to flatus (WMD = -0.79 days, 95% CI -1.14 to -0.44, P < 0.001); shorter hospital stay (WMD = -3.11 days, 95% CI -4.13 to -2.09, P < 0.001); and a decrease in complications (RR = 0.74, 95% CI 0.61 to 0.90, P = 0.003). There was no significant difference in the number of harvested lymph nodes, margin distance, mortality, cancer recurrence rate and long-term survival rate between the AGC patients treated with LG or OG (P > 0.05).

Conclusions: Despite a longer operation, LG is a safe technical alternative to OG for AGC with a lower complication rate and enhanced postoperative recovery. Moreover, there were similar outcomes between both approaches in terms of cancer recurrence and the long-term survival rate. Because of the limitation of this study, methodologically high-quality studies are needed for further evaluation.

Show MeSH
Related in: MedlinePlus