Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies

Inokuchi, Mikito; Sugita, Hirofumi; Otsuki, Sho; Sato, Yuya; Nakagawa, Masatoshi; Kojima, Kazuyuki

doi:10.1016/j.ijsu.2015.01.030

Cited by 26 publications

(19 citation statements)

References 37 publications

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“…These findings regarding pulmonary complications and pneumonia are supported by the results of other meta-analyses comparing LTG with OTG [3, 6]. In one meta-analysis comparing LDG with ODG, LDG reduced the risk of postoperative pneumonia slightly but not significantly [24]. Moreover, in a Korean RCT comparing LDG with ODG in patients with early gastric cancer, LDG was associated with a slightly but not significantly lower risk of pulmonary complications [25].…”

Section: Discussionmentioning

confidence: 72%

“…Many of the studies included in the present meta-analysis reported less operative bleeding but a longer operative time in LTG than in OTG. In a meta-analysis of LDG that included matched CCSs, the incidence of wound infection was lower in LDG than in open distal gastrectomy (ODG) [24]. In a Korean RCT comparing LDG with ODG in patients with clinical stage I gastric cancer, LDG significantly reduced wound complications such as wound infection and dehiscence [25].…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

Inokuchi

Otsuki

Ogawa

et al. 2016

Gastroenterology Research and Practice

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Background. Some meta-analyses of case-controlled studies (CCSs) have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG) had some short-term advantages over open total gastrectomy (OTG). However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients' status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients) from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29–0.85, P = 0.01, I 2 = 0%, and OR 0.46, 95% CI 0.17–0.52, P < 0.0001, I 2 = 0%). However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96–2.16, P = 0.08, I 2 = 0%). Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

Inokuchi

Otsuki

Ogawa

et al. 2016

Gastroenterology Research and Practice

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“…Laparoscopy as a minimally invasive technique has been confirmed could significantly reduce the incidence rate of postoperative surgical site infections [25]. A systematic review was conducted through comparing the surgical site infection rate between laparoscopic and open distal gastrectomy and found that laparoscopic approach was associated with a lower incidence rate of surgical site infection, especially wound infection [26]. A lower incidence of wound infection was also found for patients undergoing laparoscopic resection of colorectal cancer in comparison with those receiving an open approach [27].…”

Section: Discussionmentioning

confidence: 99%

“…However, in the meta-analysis conducted by Xiong et al, the abdominal abscess rate in patients undergoing laparoscopic total gastrectomy was lower than patients undergoing open approach, but the difference was not statistically significant [29]. Moreover, in the more recent systemic reviews and meta-analysis which contained more patients undergoing laparoscopic major gastrointestinal surgeries also reported there were no significant differences in abdominal abscess between the laparoscopic and the open approaches [26, 30, 31]. Thus, debate remains about the surgical approaches regarding abdominal abscess.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

Guo

Cao

Ding

et al. 2019

BioMed Research International

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Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

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“…The laparoscopic procedure could improve the postoperative clinical course, reduces the incidence of postoperative pneumonia and surgical site infection compared with open procedure [17] [18]. Furthermore, laparoscopic procedure is able to protect the gut drying and reduce the abdominal well trauma [19].…”

Section: Discussionmentioning

confidence: 99%

Short Term Operative Outcomes of Laparoscopic Gastric Mobilization in Esophagectomy for Esophageal Cancer: Comparison with Hand Assisted Technique

Takemura¹,

Takii²,

Kaibe³

et al. 2016

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Objective: This study evaluated the safety and operative utilities of the laparoscopic gastric mobilization compared with hand-assisted laparoscopic gastric mobilization. Patients and Methods: From April 2010 to November 2015, 125 patients with esophageal cancer have been performed laparoscopic mobilization; 33 under hand-assisted laparoscopic gastric mobilization (HLG group) and 92 under laparoscopic gastric mobilization without hand-assisted technique (LG group). Preoperative data and surgical outcomes of 2 groups were compared. Results: Preoperative data were not significantly different except for BMI. Operation time in abdominal procedure of LG group is significantly longer than HLG group (P < 0.0001). Otherwise, the blood loss and number of dissected nodes of abdominal procedure was not significantly different in two groups. The perioperative blood transfusions were needed in 7 cases (21.2%) in HLG group and 25 (27.1%) in LG group. The postoperative complications and mortality within 30 days after surgery were not significantly different in two groups. The length of hospital stay was 29 days in HLG group and 31 days in HG group, respectively. Conclusions: Our results suggested that laparoscopic gastric mobilization was safe technique and the short-term operative outcomes were comparable with that of hand-assisted laparoscopic mobilization.

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Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies

Abstract: LDG was associated with a lower incidence of SSI, especially wound infection, as compared with ODG in a meta-analysis of both RCTs and CCSs.

Cited by 26 publications

References 37 publications

Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

Short Term Operative Outcomes of Laparoscopic Gastric Mobilization in Esophagectomy for Esophageal Cancer: Comparison with Hand Assisted Technique

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