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

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.

The short-term outcome in esophagogastric junctional adenocarcinoma patients receiving total gastrectomy: laparoscopic versus open gastrectomy--a retrospective cohort study

OBJECTIVE

This study aimed to compare the quality of life in Siewert type II esophagogastric junctional adenocarcinoma patients receiving either laparoscopic total gastrectomy or open total gastrectomy.

METHODS

From Sep 1, 2008 to May 1, 2012, totally 204 consecutive patients with Siewert type II esophagogastric junctional adenocarcinoma were involved in this retrospective study. Patients were assigned to receive either laparoscopic total gastrectomy or open total gastrectomy. Details concerning the postoperative outcomes and the quality of life questionnaire were collected and compared.

RESULTS

Totally 104 patients were involved in the open gastrectomy group and 100 in the laparoscopic gastrectomy group. No differences were noted between the groups in demographics, blood loss, anastomotic leak, anastomotic stricture, hospital stay, reoperation and in-hospital mortality. Totally 188 cases of patients (92.16%) responded to the questionnaire measures during the entire follow-up period, including 93 (93%) in the laparoscopic group and 95 (91.35%) in the open group. The score of every scale and item in laparoscopic group improved much more quickly comparing with the open group, suggesting that patients in laparoscopic group recovered much more quickly than those in open group.

CONCLUSIONS

Laparoscopic total gastrectomy could lead to a significant improvement of the short-term benefits for patients with esophagogastric junctional adenocarcinoma as compared with open group.