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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

Funnel plots of each outcome.A, operative time; B, blood loss; C, harvested lymph nodes; D, first flatus day; E, first oral intake; F, hospital stay; G, postoperative complications.
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pone-0088753-g005: Funnel plots of each outcome.A, operative time; B, blood loss; C, harvested lymph nodes; D, first flatus day; E, first oral intake; F, hospital stay; G, postoperative complications.

Mentions: We used the funnel plots and Egger's linear regression test to detect publication bias for each result. When the number of studies was small, there was a limitation in this test. So the funnel plots of proximal resection margin, analgesic medication, hospital mortality, 5-year OS and DFS, were not showed. Eventually, seven funnel plots were constructed for the outcomes we most cared about. The symmetry of most outcomes on the whole was observed. All the outcomes showed no significant publication bias (P>0.05) except operative time (t = 2.93; P = 0.010) (Fig 5). Galbraith plot was used to find which articles were the contributors to heterogeneity. Then we excluded these articles and analyzed the pooling data of the rest. The same conclusions were found.


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)

Funnel plots of each outcome.A, operative time; B, blood loss; C, harvested lymph nodes; D, first flatus day; E, first oral intake; F, hospital stay; G, postoperative complications.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0088753-g005: Funnel plots of each outcome.A, operative time; B, blood loss; C, harvested lymph nodes; D, first flatus day; E, first oral intake; F, hospital stay; G, postoperative complications.
Mentions: We used the funnel plots and Egger's linear regression test to detect publication bias for each result. When the number of studies was small, there was a limitation in this test. So the funnel plots of proximal resection margin, analgesic medication, hospital mortality, 5-year OS and DFS, were not showed. Eventually, seven funnel plots were constructed for the outcomes we most cared about. The symmetry of most outcomes on the whole was observed. All the outcomes showed no significant publication bias (P>0.05) except operative time (t = 2.93; P = 0.010) (Fig 5). Galbraith plot was used to find which articles were the contributors to heterogeneity. Then we excluded these articles and analyzed the pooling data of the rest. The same conclusions were found.

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