Laparoscopic vs Open Gastrectomy: an Updated Meta-analysis of Randomized Control Trials for Short-Term Outcomes

Abstract

The aim of this meta-analysis was to compare short-term outcomes of laparoscopic and open gastrectomy for gastric cancer. EMBASE, MEDLINE, PubMed, and the Cochrane Database were searched for randomized control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30-day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2 gastrectomies, lymph node retrieval, operative time, wound complications, and intraabdominal complications. Systemic review and meta-analysis were done according to MOOSE and PRISMA guidelines. Eleven RCTs consisting of 4614 patients were included in the study. A total of 2452 patients were there in laparoscopic gastrectomy group while 2162 patients were included in open gastrectomy group. Morbidity was significantly low in laparoscopic group (p = 0.003). There was no significant difference in mortality between the two groups (P = 0.75). There were fewer wound complications in laparoscopic group and no difference intra-abdominal complications in both groups. Blood loss was significantly lesser in laparoscopic group (p < 0.001). Hospital stay was similar in both groups (p = 0.30). Operative time was significantly higher in laparoscopic group (p < 0.001). Laparoscopic group patients had a lesser number of lymph node retrieval compared to open group (p = 0.002). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies (p = 0.64). Laparoscopic gastrectomies were associated with lesser wound-related complications without decreasing hospital stay with a smaller number of lymph nodes retrieval.

The Comparison of Short- and Long-Term Outcomes for Laparoscopic Versus Open Gastrectomy for Patients With Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials

“…To the best of our knowledge, this study is not the first meta-analysis of RCTs to compare the LG with OG for the treatment of gastric cancer. Recently, Vasavada and Patel ( 35 ) performed an updated meta-analysis of 11 RCTs (6 RCTs for EGC and 5 RCTs for AGC); the results demonstrated that the LG was associated with lesser wound-related complications without decreasing the length of hospital stay. However, for the patients with AGC, most trials analyzed in previous meta-analyses were non-randomized, which may increase the risk of potential selection and publication bias.…”