Laparoscopic versus open gastrectomy for gastric cancer: A systematic review and meta-analysis of randomized controlled trials

Lou, Shenghan; Yin, Xin; Wang, Yufei; Zhang, Yao; Xue, Yingwei

doi:10.1016/j.ijsu.2022.106678

Cited by 35 publications

(20 citation statements)

References 75 publications

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“…Currently, minimally invasive surgery, including laparoscopic and robotic methods, has been widely used in the treatment of GC, especially for early GC ( 36 , 37 ). However, the oncological efficacy of minimally invasive techniques for the treatment of advanced GC is still controversial because of the concern about not being able to perform an accurate D2 lymphadenectomy and the oncological safety ( 38 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Dong

Zhang

et al. 2022

Front. Oncol.

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BackgroundIndocyanine green (ICG) imaging-guided lymphadenectomy has been introduced in gastric cancer (GC) surgery and its clinical value remains controversial. The aim of this study is to evaluate the efficacy of ICG fluorescence imaging-guided lymphadenectomy in radical gastrectomy for GC.MethodsStudies comparing lymphadenectomy in radical gastrectomy between use and non-use of ICG fluorescence imaging up to July 2022 were systematically searched from PubMed, Web of Science, Embase and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, the number of retrieved lymph nodes (LNs), the number of metastatic LNs and surgical outcomes as well as oncological outcomes. RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.Results17 studies with a total of 2274 patients (1186 in the ICG group and 1088 in the control group) undergoing radical gastrectomy and lymphadenectomy were included. In the pooled analysis, the baseline features were basically comparable. However, the number of retrieved LNs in the ICG group was significantly more than that in the control group (MD = 7.41, 95% CI = 5.44 to 9.37, P < 0.00001). No significant difference was found between the ICG and control groups in terms of metastatic LNs (MD = -0.05, 95% CI = -0.25 to 0.16, P = 0.65). In addition, the use of ICG could reduce intraoperative blood loss (MD = -17.96, 95% CI = -27.89 to -8.04, P = 0.0004) without increasing operative time (P = 0.14) and overall complications (P = 0.10). In terms of oncological outcomes, the use of ICG could reduce the overall recurrence rate (OR = 0.50; 95% CI 0.28-0.89; P = 0.02) but could not increase the 2-year overall survival rate (OR = 1.25; 95% CI 0.72-2.18; P = 0.43).ConclusionsICG imaging-guided lymphadenectomy is valuable for complete LNs dissection in radical gastrectomy for GC. However, more high-quality randomized controlled trials are needed to confirm this benefit.

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Section: Discussionmentioning

confidence: 99%

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Dong

Zhang

et al. 2022

Front. Oncol.

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“…The Korean multicenter randomized controlled trial (RCT) (KLASS-01) reported that laparoscopic distal gastrectomy for clinical stage I gastric cancer was safe and showed a lower incidence of wound complications than open distal gastrectomy [21]. In contrast, a systematic review and meta-analysis reported that the distributions of complication grades based on the Clavien-Dindo classi cation were not different between laparoscopic and open gastrectomies [33]; in this meta-analysis, laparoscopic gastrectomy had lower rates of wound complications and intra-abdominal uid collection compared with open gastrectomy. Other complications did not differ signi cantly between the two approaches.…”

Section: Discussionmentioning

confidence: 99%

Comparison of complications between laparoscopic and open gastrectomies for early gastric cancer: a nationwide propensity score-matched cohort study

Song,

Min

2023

Preprint

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Background The safety of laparoscopic gastrectomy compared with open surgery for the treatment of early gastric cancer (EGC) was not still identified on a national scale. This study aimed to compare the morbidity between laparoscopic and open gastrectomies for pathological T1 gastric cancer based on nationwide survey data. Methods Data from the Korean Gastric Cancer Association-led nationwide survey 2019 of 14,076 patients who underwent gastric cancer surgery were used. For patients with pathological T1 gastric cancer, the clinical characteristics were compared between the laparoscopic and open gastrectomy groups. Propensity score matching (PSM) was performed to match the baseline characteristics of two groups. Results Among the 7,765 patients with pathological T1 gastric cancer who underwent open or laparoscopic gastrectomy, 612 pairs were matched. After balancing the baseline characteristics, laparoscopic gastrectomy group had significantly longer operative time, less blood loss, greater number of harvested lymph nodes, shorter hospital stays, and comparable morbidity, compared with open gastrectomy group (P < 0.001, P < 0.001, P < 0.001, P = 0.001, and P = 0.709, respectively). The surgical approach was not a risk factor for postoperative complication in logistic regression analysis. Conclusions The PSM analysis with 2019 Korean nationwide survey data demonstrated that laparoscopic gastrectomy showed comparable morbidity with open gastrectomy for EGC.

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“…For patients diagnosed with early-stage gastric cancer, total, subtotal, or distal gastrectomy with D2 lymphadenectomy offers a curative treatment option (14). In recent times, laparoscopic gastrectomy, performed by skilled surgeons, has gained prominence due to its associated benefits, such as reduced blood loss, fewer post-operative complications, and quicker recovery (15). A recent systematic review and meta-analysis of 16 studies comparing robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer indicated that RG is associated with a decreased risk of postoperative complications, shorter hospital stays, and lower rates of conversion to open surgery.…”

Section: Time To Surgerymentioning

confidence: 99%

Time to treatment disparities in gastric cancer patients in the United States of America: a comprehensive retrospective analysis

Sharan,

Bansal,

Manaise

et al. 2024

Front. Oncol.

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IntroductionGastric cancer ranks as the 5th most prevalent cancer and the 4th leading cause of cancer-related deaths worldwide. Various treatment modalities, including surgical resection, chemotherapy, and radiotherapy, are available for gastric cancer patients. However, disparities related to age, sex, race, socioeconomic factors, insurance status, and demographic factors often lead to delayed time to treatment.MethodsIn this retrospective study, conducted between 2004 and 2019, we utilized data from the National Cancer Database (NCDB) to investigate the factors contributing to disparities in the time to first treatment, surgery, chemotherapy, and radiotherapy among gastric cancer patients. Our analysis incorporated several variables, and statistical analysis was conducted to provide valuable insights into these disparities.ResultsWe observed notable disparities in the timing of treatment for various demographic groups, including age, sex, race, insurance status, geographic location, and facility type. These disparities include longer time to treatment in males (32.67 vs 30.75), Native Americans (35.10 vs 31.09 in Asians), low-income patients (32 vs 31.15), patients getting treatment in an academic setting (36.11 vs 29.61 in community setting), significantly longer time to chemotherapy in 70+ age group (51.13 vs 40.38 in <40 y age group), black race (55.81 vs 47.05 in whites), low income people (49.64 vs 46.74), significantly longer time to radiotherapy in females (101.61 vs 79.75), blacks and Asians (109.68 and 113.96 respectively vs 92.68 in Native Americans) etc. There are various other disparities in time to surgery, chemotherapy, and radiotherapy.ConclusionsUnderstanding these disparities is crucial in developing targeted strategies to improve timely access to appropriate treatments and enhance outcomes for gastric cancer patients. Future research with updated data and prospective study designs can provide a more comprehensive understanding of the factors influencing patient outcomes in gastric cancer.

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Laparoscopic versus open gastrectomy for gastric cancer: A systematic review and meta-analysis of randomized controlled trials

Cited by 35 publications

References 75 publications

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Comparison of complications between laparoscopic and open gastrectomies for early gastric cancer: a nationwide propensity score-matched cohort study

Time to treatment disparities in gastric cancer patients in the United States of America: a comprehensive retrospective analysis

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