Laparoscopic versus open gastrectomy for gastric cancer

Best, Lawrence; Mughal, Muntzer; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd011389.pub2

Cited by 94 publications

(79 citation statements)

References 66 publications

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“…Some literature concluded that LADG was associated with a lower postoperative complication rate in AGC patients [26, 27]; others found no significant difference between LADG and ODG concerning postoperative morbidity [14, 28]. Even a meta-analysis reported by Cochrane Database considered that the evidence qualities of most completed or ongoing RCTs were low because of high risks of bias [29]. Since operative safety is an essential prerequisite and basis for new surgical procedures, well-designed trials are needed to validate the safety and efficacy of LADG for AGC patients.…”

Section: Discussionmentioning

confidence: 99%

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

et al. 2018

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BackgroundAlthough laparoscopic surgery has been recommended as an optional therapy for patients with early gastric cancer, whether patients with locally advanced gastric cancer (AGC) could benefit from laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy remains elusive due to a lack of comprehensive clinical data. To evaluate the efficacy of LADG, we conducted a multi-institutional randomized controlled trial to compare laparoscopy-assisted versus open distal gastrectomy (ODG) for AGC in North China.MethodsIn this RCT, after patients were enrolled according to the eligibility criteria, they were preoperatively assigned to LADG or ODG arm randomly with a 1:1 allocation ratio. The primary endpoint was the morbidity and mortality within 30 postoperative days to evaluate the surgical safety of LADG. The secondary endpoint was 3-year disease-free survival. This trial was registered at ClinicalTrial.gov as NCT02464215.ResultsBetween March 2014 and August 2017, a total of 446 patients with cT2-4aN0-3M0 (AJCC 7th staging system) were enrolled. Of these, 222 patients underwent LADG and 220 patients underwent ODG were included in the modified intention-to-treat analysis. The compliance rate of D2 lymph node dissection was identical between the LADG and ODG arms (99.5%, P = 1.000). No significant difference was observed regarding the overall postoperative complication rate in two groups (LADG 13.1%, ODG 17.7%, P = 0.174). No operation-related death occurred in both arms.ConclusionsThis trial confirmed that LADG performed by credentialed surgeons was safe and feasible for patients with AGC compared with conventional ODG.

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Section: Discussionmentioning

confidence: 99%

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

et al. 2018

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“…Gastric cancer (GC) is the fourth most common malignant disease and the third leading cause of cancer-related deaths worldwide [1, 2]. Almost 50% of gastric cancer patients are Chinese, many of whom are diagnosed with advanced stage cancer [3].…”

Section: Introductionmentioning

confidence: 99%

The Role of Tumoral FOXP3 on Cell Proliferation, Migration, and Invasion in Gastric Cancer

Zhang

et al. 2017

Cell Physiol Biochem

3,265

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Background/Aims: There is little published data on the role of FOXP3 in gastric cancer. Methods: FOXP3 expression and localization in gastric cancer tissues and cells were examined by immunohistochemistry, RT-PCR, flow cytometry, western blot, and laser confocal microscopy. CCK8, plate clone, wound healing, and transwell insert assays were performed for gastric cancer cells. Potential molecules and signaling pathways were screened using high-throughput transcriptome sequencing. Results: FOXP3 expression in gastric cancer tissues was higher than that in para-carcinoma tissues. It was restricted to the cytoplasm of para-carcinoma tissues, but was observed in the cytoplasm or/and nuclei of gastric cancer tissues. FOXP3 expression was positively correlated with pathological grading, and was detected in gastric cancer and GES-1 cells, where it was expressed in the cytoplasm alone, or in both the cytoplasm and the nucleus. FOXP3 overexpression promoted cell proliferation, migration, and invasion, while FOXP3 knockdown suppressed these effects. Furthermore, RT-PCR and ELISA confirmed that FOXP3 upregulation resulted in increased TGF-β expression and secretion in gastric cancer cells. Conclusion: FOXP3 expression was associated with degree of gastric cancer differentiation. In addition, upregulated and ectopic tumoral FOXP3 can promote gastric cancer proliferation, migration, and invasion, partly through the TGF-β pathway.

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“…It was recently reported in Cochrane Database of Systematic Reviews that there was no evidence for any differences in short‐term or long‐term outcomes between open and laparoscopic gastrectomy . However, the data are sparse, and the CIs were wide, suggesting that significant benefits or harms of laparoscopic gastrectomy cannot be ruled out.…”

Section: Discussionmentioning

confidence: 99%

“…Reviews that there was no evidence for any differences in short-term or long-term outcomes between open and laparoscopic gastrectomy. 93 However, the data are sparse, and the CIs were wide, suggesting that significant benefits or harms of laparoscopic gastrectomy cannot be ruled out. With respect to surgical methods used for SLN detection, our subgroup analysis did not found significant differences between open and laparoscopic gastrectomy.…”

Section: It Was Recently Reported In Cochrane Database Of Systematicmentioning

confidence: 99%

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Jiang

Wang

et al. 2018

Journal of Surgical Oncology

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Background This meta‐analysis was conducted to evaluate the diagnostic value of near‐infrared (NIR) or fluorescent indocyanine green (ICG) guided sentinel lymph node (SLN) mapping in gastric cancer (GC). Methods This meta‐analysis was registered at the PROSPERO. Clinical studies were retrieved from the electronic database Pubmed, Embase, Medline, Web of science, and the Cochrane Library. Quality assessment was conducted by an adapted checklist of QUADAS‐2. A bivariate mixed‐effects model was used to pool the data. Evaluation of articles quality, analysis for publication bias, summary receiver operator characteristic (SROC) curves, and meta‐regression were also performed. Subgroup analysis was used to explain the heterogeneities. Results A total of 13 clinical studies (971 patients) were included. The NIR or fluorescent imaging (FI) involved infrared ray electronic endoscopy (IREE), infrared ray laparoscopic system (IRLS), and FI system. Significant evidence of heterogeneity was found for sensitivity and specificity (I 2 = 91.1% and I 2 = 98.2%), respectively. The pooled SLN sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.94(95%CI: 0.80‐0.99), 1.00(95%CI: 0.60‐1.00), 34.0(95%CI: 9.25‐125.29), 0.06(95%CI:0.02‐0.22), and 252.50(95%CI: 94.93‐671.61), respectively. Area under curve (AUC) of SROC curve was 1.00 (95%CI: 0.99‐1.00), and the summary operating point (cut‐off value) was SENS = 0.94(95%CI: 0.80‐0.99) and SPEC = 1.00(95%CI: 0.60‐1.00). Subgroup analysis showed that NIR imaging, imaging performed 20 minutes after intraoperative injection, preoperative injection (especially for FI imaging), stained with immunohistochemistry (IHC) (+hematoxylin‐eosin [HE]), cT1 stage, submucosa injection (especially for cT1), mean number of SLN ≥ 5, study size > 26 were associated with higher SLN sensitivity. In terms of ICG concentration, diluted ICG concentration that 0.5 mg/mL (compared with 5 mg/mL) in NIR imaging and 0.05 mg/mL (compared with 0.5 mg/mL) in FI system showed higher sensitivities. However, the differences in tumor diameter (≤30 mm vs >30 mm), gastrectomy methods (opening vs laparoscopy), lymphadenectomy methods (LBD vs pick‐up), and publication year (≥2010 vs <2010) did not achieve statistical significance. Conclusion ICG combined with NIR or FI guided SLN mapping is technically feasible for GC. Based on the small sample size evidence, the IREE and IRLS devices may have higher sensitivity than FI in current clinical studies; and there may be an excessive ICG concentration used for current SLN mapping in GC. However, well‐designed further studies with large sample size are needed to confirm the best procedure and suitable criteria. Mini‐abstract This meta‐analysis was registered at PROSPERO. Clinical studies on this topic were retrieved from the electronic database Pubmed, Embase, Medline, Web of Science, and the Cochrane Library. The NIR or FI involved IREE, IRLS, and FI techniques. A total of 13 clinical studies (9...

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Laparoscopic versus open gastrectomy for gastric cancer

Cited by 94 publications

References 66 publications

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

The Role of Tumoral FOXP3 on Cell Proliferation, Migration, and Invasion in Gastric Cancer

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

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