Limits...
Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer.

Zhang YX, Wu YJ, Lu GW, Xia MM - World J Surg Oncol (2015)

Bottom Line: Estimated blood loss was significantly less in TLDG than that in LAG (P < 0.01).Compared to LADG, TLDG also involved lesser postoperative hospital stay (P < 0.01) and earlier time to soft diet intake (P < 0.05).TLDG may be a technically safe, feasible, and favorable approach in terms of better cosmesis, less blood loss, and faster recovery compared with LADG.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China. 248791664@qq.com.

ABSTRACT

Background: Totally laparoscopic distal gastrectomy (TLDG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopic assisted distal gastrectomy (LADG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals.

Methods: A systematic review of the two operation types (LADG and TLDG) was carried out to evaluate short-term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications, and hospital stay.

Results: Twelve non-randomized observational clinical studies involving 2,255 patients satisfied the eligibility criteria. Operative time was not statistically different between groups (P > 0.05). The number of retrieved lymph nodes and the resection margin length in TLDG were comparable with those in LADG. Estimated blood loss was significantly less in TLDG than that in LAG (P < 0.01). Compared to LADG, TLDG also involved lesser postoperative hospital stay (P < 0.01) and earlier time to soft diet intake (P < 0.05). Time to flatus and postoperative complications were similar for those two operative approaches.

Conclusions: TLDG may be a technically safe, feasible, and favorable approach in terms of better cosmesis, less blood loss, and faster recovery compared with LADG.

No MeSH data available.


Related in: MedlinePlus

Funnel plots of the overall postoperative complications. RR, risk ratio; SE, standard error.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4384388&req=5

Fig9: Funnel plots of the overall postoperative complications. RR, risk ratio; SE, standard error.

Mentions: Morbidity was described in all 12 studies [16-27], and there was no significant difference in postoperative morbidity (RR = 0.97, 95% CI, 0.75 to 1.27, P = 0.85) (Figure 8). Visual inspection of the funnel plot revealed symmetry, indicating no serious publication bias (Figure 9). After further analysis, anastomotic-related complications, which were classified as anastomotic leakage, stenosis, and hemorrhage, were also similar between the two groups (RR = 0.86, 95% CI, 0.46 to 1.63, P = 0.65), as was the rate of abdominal abscess or fluid collection (RR = 1.08, 95% CI, 0.51 to 2.29, P = 0.84). The specific postoperative complications included in the studies are summarized in Table 4.Figure 8


Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer.

Zhang YX, Wu YJ, Lu GW, Xia MM - World J Surg Oncol (2015)

Funnel plots of the overall postoperative complications. RR, risk ratio; SE, standard error.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384388&req=5

Fig9: Funnel plots of the overall postoperative complications. RR, risk ratio; SE, standard error.
Mentions: Morbidity was described in all 12 studies [16-27], and there was no significant difference in postoperative morbidity (RR = 0.97, 95% CI, 0.75 to 1.27, P = 0.85) (Figure 8). Visual inspection of the funnel plot revealed symmetry, indicating no serious publication bias (Figure 9). After further analysis, anastomotic-related complications, which were classified as anastomotic leakage, stenosis, and hemorrhage, were also similar between the two groups (RR = 0.86, 95% CI, 0.46 to 1.63, P = 0.65), as was the rate of abdominal abscess or fluid collection (RR = 1.08, 95% CI, 0.51 to 2.29, P = 0.84). The specific postoperative complications included in the studies are summarized in Table 4.Figure 8

Bottom Line: Estimated blood loss was significantly less in TLDG than that in LAG (P < 0.01).Compared to LADG, TLDG also involved lesser postoperative hospital stay (P < 0.01) and earlier time to soft diet intake (P < 0.05).TLDG may be a technically safe, feasible, and favorable approach in terms of better cosmesis, less blood loss, and faster recovery compared with LADG.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China. 248791664@qq.com.

ABSTRACT

Background: Totally laparoscopic distal gastrectomy (TLDG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopic assisted distal gastrectomy (LADG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals.

Methods: A systematic review of the two operation types (LADG and TLDG) was carried out to evaluate short-term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications, and hospital stay.

Results: Twelve non-randomized observational clinical studies involving 2,255 patients satisfied the eligibility criteria. Operative time was not statistically different between groups (P > 0.05). The number of retrieved lymph nodes and the resection margin length in TLDG were comparable with those in LADG. Estimated blood loss was significantly less in TLDG than that in LAG (P < 0.01). Compared to LADG, TLDG also involved lesser postoperative hospital stay (P < 0.01) and earlier time to soft diet intake (P < 0.05). Time to flatus and postoperative complications were similar for those two operative approaches.

Conclusions: TLDG may be a technically safe, feasible, and favorable approach in terms of better cosmesis, less blood loss, and faster recovery compared with LADG.

No MeSH data available.


Related in: MedlinePlus