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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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Meta-analysis of the pooled data: number of retrieved lymph nodes.
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Figure 2: Meta-analysis of the pooled data: number of retrieved lymph nodes.

Mentions: The mean operating time of LG was 48.67 min longer than for OG (WMD = 48.67 min, 95% CI 34.09 to 63.26, P < 0.001). The intraoperative blood loss was lower in LG than in OG (WMD = −139.01 ml, 95% CI −174.57 to −103.44, P < 0.001). All studies contained the number of retrieved lymph nodes. The difference in the mean number of retrieved lymph nodes between LG and OG was not significant in the pooled data (WMD = −0.07, 95% CI −1.03 to 0.89, P = 0.88) (Figure 2). Meta-analysis of the distal margin distance showed no significant difference between the two groups (WMD = 0.08 cm, 95% CI −0.16 to 0.32, P = 0.50). However, the proximal margin distance of OG was longer than that of LG with a marginal difference (WMD = −0.26 cm, 95% CI −0.54 to 0.01, P = 0.06). All intraoperative effect outcomes are summarized in Table 2.


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)

Meta-analysis of the pooled data: number of retrieved lymph nodes.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Meta-analysis of the pooled data: number of retrieved lymph nodes.
Mentions: The mean operating time of LG was 48.67 min longer than for OG (WMD = 48.67 min, 95% CI 34.09 to 63.26, P < 0.001). The intraoperative blood loss was lower in LG than in OG (WMD = −139.01 ml, 95% CI −174.57 to −103.44, P < 0.001). All studies contained the number of retrieved lymph nodes. The difference in the mean number of retrieved lymph nodes between LG and OG was not significant in the pooled data (WMD = −0.07, 95% CI −1.03 to 0.89, P = 0.88) (Figure 2). Meta-analysis of the distal margin distance showed no significant difference between the two groups (WMD = 0.08 cm, 95% CI −0.16 to 0.32, P = 0.50). However, the proximal margin distance of OG was longer than that of LG with a marginal difference (WMD = −0.26 cm, 95% CI −0.54 to 0.01, P = 0.06). All intraoperative effect outcomes are summarized in Table 2.

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