Systematic review and meta-analysis of laparoscopic versus open distal gastrectomy

Qiuye Cheng, Tony C. Y. Pang, Michael J. Hollands, Arthur J. Richardson, Henry Pleass, Emma S. Johnston, Vincent W. T. Lam

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18 Citations (Scopus)

Abstract

Background: Laparoscopic distal gastrectomy has been increasingly utilized in the treatment of gastric adenocarcinoma. This study aims to compare the morbidity/mortality and postoperative outcomes of laparoscopic-assisted versus open distal gastrectomy since 2000. Methods: A comprehensive search of MEDLINE and EMBASE was conducted including studies published between 2000 and present. Results: Seventeen studies with a total of 7,109 distal gastrectomies (3,496 lap vs 3,613 open) were included. Across all studies, postoperative morbidity rates for laparoscopic gastrectomy were lower than that of open [median (range) 10 (0-36) % vs 17 (0-43) %]. Meta-analysis of postoperative morbidity rates in prospective studies only yielded pooled odds ratio of 0.52 (95 % CI 0.33-0.81) (P = 0.004). In-hospital mortality rates were comparable between the two (range: laparoscopic 0-3.3 vs open 0-6.7 %). The long-term oncological outcomes of resection were difficult to analyze given variable reporting but appeared similar between the two. Meta-analysis of prospective studies showed that laparoscopic-assisted distal gastrectomy was associated with significantly shorter hospital length of stay [standard mean difference (SMD) = -0.78 (95 % CI = -1.0 to -0.56)], comparable intraoperative bleeding [SMD = 0.64 (95 % CI = -1.3-0.0430) P = 0.066] and longer operative time compared to open gastrectomy [1.9 (95 % CI 0.05-3.8) P = 0.045, with P < 0.001]. Conclusion: This study supports the use of laparoscopic-assisted distal gastrectomy for treatment of gastric adenocarcinoma with evidence of comparable, if not better, short-term postoperative parameters when compared to open distal gastrectomy. The long-term oncological outcomes appear similar but may require more evaluation.

Original languageEnglish
Pages (from-to)1087-1099
Number of pages13
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number6
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

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Keywords

  • Gastric cancer
  • Laparoscopic distal gastrectomy
  • Meta-analysis
  • Mortality
  • Open distal gastrectomy
  • Post-op complications

Cite this

Cheng, Q., Pang, T. C. Y., Hollands, M. J., Richardson, A. J., Pleass, H., Johnston, E. S., & Lam, V. W. T. (2014). Systematic review and meta-analysis of laparoscopic versus open distal gastrectomy. Journal of Gastrointestinal Surgery, 18(6), 1087-1099. https://doi.org/10.1007/s11605-014-2519-z