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Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis.

Wang JF, Zhang SZ, Zhang NY, Wu ZY, Feng JY, Ying LP, Zhang JJ - World J Surg Oncol (2016)

Bottom Line: No significant differences were observed between LG and OG for the number of harvested lymph nodes.However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01).Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.

ABSTRACT

Background: The objective of this study was to evaluate the feasibility, safety, and potential benefits of laparoscopic gastrectomy (LG) comparing with open gastrectomy (OG) in elderly population.

Methods: Studies comparing LG with OG for elderly population with gastric cancer, published between January 1994 and July 2015, were identified in the PubMed, Embase, and ISI Web of Science databases. Operative outcomes (intraoperative blood loss, operative time, and the number of lymph nodes harvested) and postoperative outcomes (time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity) were included and analyzed. The Newcastle-Ottawa Scale was used to assess the quality of the pooled study. A funnel plot was used to evaluate the publication bias.

Results: Seven studies totaling 845 patients were included in the meta-analysis. LG in comparison to OG showed less intraoperative blood loss (weighted mean difference (WMD) -127.47; 95% confidence interval (CI) -202.79 to -52.16; P < 0.01), earlier time to first ambulation (WMD -2.07; 95% CI -2.84 to -1.30; P < 0.01), first flatus (WMD -1.04; 95% CI -1.45 to -0.63; P < 0.01), and oral intake (WMD -0.94; 95% CI -1.11 to -0.77; P < 0.01), postoperative hospital stay (WMD -5.26; 95% CI -7.58 to -2.93; P < 0.01), lower overall postoperative complication rate (odd ratio (OR) 0.39; 95% CI 0.28 to 0.55; P < 0.01), less surgical complications (OR 0.47; 95% CI 0.32 to 0.69; P < 0.01), medical complication (OR 0.35; 95% CI 0.22 to 0.56; P < 0.01), incisional complication (OR 0.40; 95% CI 0.19 to 0.85; P = 0.02), and pulmonary infection (OR 0.49; 95% CI 0.26 to 0.93; P = 0.03). No significant differences were observed between LG and OG for the number of harvested lymph nodes. However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01).

Conclusions: LG is a feasible and safe approach for elderly patients with gastric cancer. Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the identification and inclusion of studies
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Fig1: Flow chart of the identification and inclusion of studies

Mentions: The search strategy initially identified 2069 studies. After exclusion of irrelevant studies, 20 potentially relevant articles were obtained for assessment. Thirteen studies were excluded due to non-comparative studies, did not compare LG with OG, and including palliative gastrectomy cases. Finally, seven studies (three from Japan and four from China) published between 2004 and 2015 were included [20–26]. The PRISMA flowchart of literature review is shown in Fig. 1. The characteristics of these seven studies are summarized in Table 1. A total of 845 patients from East Asia were pooled in this meta-analysis: 422 in the LG group and 423 in the OG group. Patients more than 70 years old were categorized as elderly patients in four studies [20, 21, 24, 25], more than 65 years old in two studies [22, 23], and more than 75 years old in one study [26]. Patients from Japan mostly suffered early gastric cancer and underwent D1 or D1+ lymphadenectomy, while the majority of patients from China suffered advanced gastric cancer and underwent D2 lymphadenectomy. Three studies compared the prognostic outcomes and demonstrated no significant difference between LG and OG. Oncological outcomes of included studies are showed in Table 2. All seven studies were methodologically sound with no less than six stars (Table 3).Fig. 1


Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis.

Wang JF, Zhang SZ, Zhang NY, Wu ZY, Feng JY, Ying LP, Zhang JJ - World J Surg Oncol (2016)

Flow chart of the identification and inclusion of studies
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4815084&req=5

Fig1: Flow chart of the identification and inclusion of studies
Mentions: The search strategy initially identified 2069 studies. After exclusion of irrelevant studies, 20 potentially relevant articles were obtained for assessment. Thirteen studies were excluded due to non-comparative studies, did not compare LG with OG, and including palliative gastrectomy cases. Finally, seven studies (three from Japan and four from China) published between 2004 and 2015 were included [20–26]. The PRISMA flowchart of literature review is shown in Fig. 1. The characteristics of these seven studies are summarized in Table 1. A total of 845 patients from East Asia were pooled in this meta-analysis: 422 in the LG group and 423 in the OG group. Patients more than 70 years old were categorized as elderly patients in four studies [20, 21, 24, 25], more than 65 years old in two studies [22, 23], and more than 75 years old in one study [26]. Patients from Japan mostly suffered early gastric cancer and underwent D1 or D1+ lymphadenectomy, while the majority of patients from China suffered advanced gastric cancer and underwent D2 lymphadenectomy. Three studies compared the prognostic outcomes and demonstrated no significant difference between LG and OG. Oncological outcomes of included studies are showed in Table 2. All seven studies were methodologically sound with no less than six stars (Table 3).Fig. 1

Bottom Line: No significant differences were observed between LG and OG for the number of harvested lymph nodes.However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01).Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Yinzhou People's Hospital, Yinzhou Hospital Affiliated to Medical School of Ningbo University, 251 Baizhang Road, Ningbo, 315040, Zhejiang, People's Republic of China.

ABSTRACT

Background: The objective of this study was to evaluate the feasibility, safety, and potential benefits of laparoscopic gastrectomy (LG) comparing with open gastrectomy (OG) in elderly population.

Methods: Studies comparing LG with OG for elderly population with gastric cancer, published between January 1994 and July 2015, were identified in the PubMed, Embase, and ISI Web of Science databases. Operative outcomes (intraoperative blood loss, operative time, and the number of lymph nodes harvested) and postoperative outcomes (time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity) were included and analyzed. The Newcastle-Ottawa Scale was used to assess the quality of the pooled study. A funnel plot was used to evaluate the publication bias.

Results: Seven studies totaling 845 patients were included in the meta-analysis. LG in comparison to OG showed less intraoperative blood loss (weighted mean difference (WMD) -127.47; 95% confidence interval (CI) -202.79 to -52.16; P < 0.01), earlier time to first ambulation (WMD -2.07; 95% CI -2.84 to -1.30; P < 0.01), first flatus (WMD -1.04; 95% CI -1.45 to -0.63; P < 0.01), and oral intake (WMD -0.94; 95% CI -1.11 to -0.77; P < 0.01), postoperative hospital stay (WMD -5.26; 95% CI -7.58 to -2.93; P < 0.01), lower overall postoperative complication rate (odd ratio (OR) 0.39; 95% CI 0.28 to 0.55; P < 0.01), less surgical complications (OR 0.47; 95% CI 0.32 to 0.69; P < 0.01), medical complication (OR 0.35; 95% CI 0.22 to 0.56; P < 0.01), incisional complication (OR 0.40; 95% CI 0.19 to 0.85; P = 0.02), and pulmonary infection (OR 0.49; 95% CI 0.26 to 0.93; P = 0.03). No significant differences were observed between LG and OG for the number of harvested lymph nodes. However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01).

Conclusions: LG is a feasible and safe approach for elderly patients with gastric cancer. Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.

No MeSH data available.


Related in: MedlinePlus