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Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis.

Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z - PLoS ONE (2014)

Bottom Line: LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity.LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time.There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

ABSTRACT

Objective: To expand the current knowledge on the feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric cancer in comparison with open total gastrectomy (OTG).

Background: Additional studies comparing laparoscopic versus open total gastric resection have been published, and it is necessary to update the meta-analysis of this subject.

Methods: Original articles compared LTG and OTG for gastric cancer, which published in English from January 1990 to July 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, proximal resection margin, analgesic medication, first flatus day, first oral intake, postoperative hospital stay, postoperative complications, hospital mortality, 5-year overall survival (OS) and disease-free survival (DFS) were compared using STATA version 10.1.

Results: 17 studies were selected in this analysis, which included a total of 2313 patients (955 in LTG and 1358 in OTG). LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. The number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar.

Conclusion: LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time. There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG. A positive trend was indicated towards LTG. So LTG can be performed as an alternative to OTG by the experienced surgeons in high-volume centers. Whereas, due to the relative small sample size of long-term outcomes and lack of randomized control trials, more studies are required.

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Related in: MedlinePlus

Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.
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pone-0088753-g002: Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.

Mentions: There was a longer duration of operative time in the LTG group than that in the OTG group (WMD, 47.00; 95% CI, 31.67, 62.33; P<0.001) (Fig 2A). However, significant heterogeneity (I2 = 93.1%, P<0.001) and the publication bias (t = 2.93; P = 0.010) were observed. Therefore, we used the Galbraith plot to find the source of heterogeneity [24], [25], [28], [29], [31], [35], [37]–[39], and excluded them all. Then, we meta-analyzed this subject again and still found the same outcome (WMD, 22.86; 95% CI, 17.18, 28.53; P<0.001) with low heterogeneity (I2<0.1%, P = 0.890) and no publication bias (t = 0.31; P = 0.764). Blood loss during the operation was decreased under the laparoscopic procedure (WMD, −179.60; 95% CI, −251.80, −107.89; P<0.001) (Fig 2B). No statistical difference was found between the two groups in the number of harvested lymph nodes (WMD, 2.33; 95% CI, −0.04, 4.71; P = 0.054) (Fig 2C). We also analyzed the retrieval of lymph nodes under the modified D2 lymphadenectomy between LTG and OTG, and no difference was discovered (WMD, 0.70; 95% CI, −0.80, 2.20; P = 0.361) (Fig 2D). Moreover, the effect of No. 10 lymph nodes dissection under D2 lymphadenectomy on the number of harvested lymph nodes was assessed, and no significant difference between the two groups was found (with No. 10 lymph nodes dissection: WMD, −0.40; 95% CI, −2.55, 1.75; P = 0.715; without No. 10 lymph nodes dissection: WMD, 1.76; 95% CI, −0.35, 3.87; P = 0.102). The length of the proximal resection margin was similar for either group (WMD, 0.06; 95% CI, −0.26, 0.39; P = 0.706) (Fig 2E).


Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis.

Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z - PLoS ONE (2014)

Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928285&req=5

pone-0088753-g002: Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.
Mentions: There was a longer duration of operative time in the LTG group than that in the OTG group (WMD, 47.00; 95% CI, 31.67, 62.33; P<0.001) (Fig 2A). However, significant heterogeneity (I2 = 93.1%, P<0.001) and the publication bias (t = 2.93; P = 0.010) were observed. Therefore, we used the Galbraith plot to find the source of heterogeneity [24], [25], [28], [29], [31], [35], [37]–[39], and excluded them all. Then, we meta-analyzed this subject again and still found the same outcome (WMD, 22.86; 95% CI, 17.18, 28.53; P<0.001) with low heterogeneity (I2<0.1%, P = 0.890) and no publication bias (t = 0.31; P = 0.764). Blood loss during the operation was decreased under the laparoscopic procedure (WMD, −179.60; 95% CI, −251.80, −107.89; P<0.001) (Fig 2B). No statistical difference was found between the two groups in the number of harvested lymph nodes (WMD, 2.33; 95% CI, −0.04, 4.71; P = 0.054) (Fig 2C). We also analyzed the retrieval of lymph nodes under the modified D2 lymphadenectomy between LTG and OTG, and no difference was discovered (WMD, 0.70; 95% CI, −0.80, 2.20; P = 0.361) (Fig 2D). Moreover, the effect of No. 10 lymph nodes dissection under D2 lymphadenectomy on the number of harvested lymph nodes was assessed, and no significant difference between the two groups was found (with No. 10 lymph nodes dissection: WMD, −0.40; 95% CI, −2.55, 1.75; P = 0.715; without No. 10 lymph nodes dissection: WMD, 1.76; 95% CI, −0.35, 3.87; P = 0.102). The length of the proximal resection margin was similar for either group (WMD, 0.06; 95% CI, −0.26, 0.39; P = 0.706) (Fig 2E).

Bottom Line: LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity.LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time.There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

ABSTRACT

Objective: To expand the current knowledge on the feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric cancer in comparison with open total gastrectomy (OTG).

Background: Additional studies comparing laparoscopic versus open total gastric resection have been published, and it is necessary to update the meta-analysis of this subject.

Methods: Original articles compared LTG and OTG for gastric cancer, which published in English from January 1990 to July 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, proximal resection margin, analgesic medication, first flatus day, first oral intake, postoperative hospital stay, postoperative complications, hospital mortality, 5-year overall survival (OS) and disease-free survival (DFS) were compared using STATA version 10.1.

Results: 17 studies were selected in this analysis, which included a total of 2313 patients (955 in LTG and 1358 in OTG). LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. The number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar.

Conclusion: LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time. There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG. A positive trend was indicated towards LTG. So LTG can be performed as an alternative to OTG by the experienced surgeons in high-volume centers. Whereas, due to the relative small sample size of long-term outcomes and lack of randomized control trials, more studies are required.

Show MeSH
Related in: MedlinePlus