Short-and long-term outcomes of laparoscopic versus open gastrectomy in patients with gastric cancer: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background Laparoscopic gastrectomy (LG) for gastric cancer has rapidly developed and become more popular in recent decades. Additional high-quality randomized controlled trial (RCT) studies comparing LG versus open gastrectomy (OG) for gastric cancer (GC) have been published in recent years. An updated systematic review is warranted. The aim of our meta-analysis was to comprehensively evaluate the short- and long-term outcomes of LG versus OG for GC. Materials and methods The PubMed, Embase, Web of Science, and Cochrane Center Register of Controlled Trials databases were comprehensively searched to identify RCTs comparing LG versus OG for GC published between January 1994 and December 7, 2021. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Collaboration and the Quality of Reporting of Meta-analyses (QUORUM) guidelines. All RCTs comparing the short- and long-term outcomes of LG with those of OG were included. A random effects model was adopted with significant heterogeneity (I2 > 50%), while a fixed effects model was employed in all other cases (I2 ≤ 50%). Results A total of 26 RCTs with 8301 patients were included in this meta-analysis. The results indicated that the intraoperative complication rate was comparable between the LG group and the OG group (OR=1.14, 95% CI [0.76, 1.70], I2=0%, p=0.53). The LG group had fewer postoperative complications than the OG group (OR=0.65, 95% CI [0.57, 0.74], I2=26%, p<0.00001). However, the severe postoperative complication rate and perioperative mortality were comparable between the two groups (OR=0.83, 95% CI [0.67, 1.04], I2=10%, p=0.10; OR=1.11, 95% CI [0.59, 2.09], I2=0%, p=0.74, respectively). The number of lymph nodes retrieved by the LG group was less than that of the OG group (MD=−1.51, 95% CI [−2.29, −0.74], I2=0%, p<0.0001). The proximal resection margin distance in the LG group was shorter than that in the OG group (MD=−0.34, 95% CI [−0.57, −0.12], I2=23%, p=0.003), but the distal resection margin distance in the two groups was comparable (MD=−0.21, 95% CI [−0.47, 0.04], I2=0%, p=0.10). The time to first ambulation was shorter in the LG group than in the OG group (MD=−0.14, 95% CI [−.26, −0.01], I2=40%, p=0.03). The time to first flatus was also shorter in the LG group than in the OG group (MD=−0.15, 95% CI [−0.23, −0.07], I2=4%, p=0.0001). However, the first time on a liquid diet was comparable between the two groups (MD=−0.30, 95% CI [−0.64, 0.04], I2=88%, p=0.09). Furthermore, the postoperative length of stay was shorter in the LG group than in the OG group (MD=−1.26, 95% CI [−1.99, −0.53], I2=90%, p=0.0007). The 5-year overall survival (OS) was comparable between the two groups (HR=0.97, 95% CI [0.80, 1.17], I2=0%, p=0.73), and the 5-year disease-free survival (DFS) was also similar between the LG group and OG group (HR=1.08, 95% CI [0.77, 1.52], I2=0%, p=0.64). Conclusion LG is a technically safe and feasible alternative to OG with the advantages of a fewer postoperative complication rate, faster recovery of gastrointestinal function, and greater cosmetic benefit for patients with GC. Meanwhile, LG has comparable long-term outcomes to OG for GC.

Comparison of Postoperative Complications After Gastrectomy for Gastric Cancer with Antecolic Versus Retrocolic Reconstruction: A Population-Based Study

“… 7 A systematic review and meta-analysis of randomized controlled trials (a total of 26 RCTs with 8301 patients) did not find significant differences in anastomotic leakages between the laparoscopic and open approaches. 19 The rate of anastomotic leakage was 1.7% in patients undergoing laparoscopic total gastrectomy with antecolic Roux-en-Y reconstruction compared with a rate of 4.2% after open total gastrectomy in the series of 329 gastric cancer patients in a single-center study. 20 Furthermore, antecolic reconstruction was not associated with anastomotic leakages in the meta-analysis of 13,660 patients undergoing laparoscopic Roux-en-Y gastric bypass.…”

The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials

“…So far, our study firstly performed systematic review and meta-analysis on the efficacy and safety of ERAS in LDG. Previous studies had summarized the role of laparoscopy in GC surgery [ 47–50 ], as well as the use of ERAS Program in open and laparoscopic gastrectomy [ 19 , 21 , 51–56 ]. However, our study only focused on the clinical application of ERAS in LDG patients.…”

Prognostic Relevance of Preoperative Immune, Inflammatory, and Nutritional Biomarkers in Patients Undergoing Gastrectomy for Resectable Gastric Adenocarcinoma: An Observational Multicentre Study

“…Gastric cancer is one of the most common malignancies worldwide, with few improvements in overall long-term results in recent decades [ 1 , 2 , 3 ]. Surgery remains the main treatment in candidates for curative intent, but perioperative adjuvant treatment has been shown to improve survival in patients with non-metastatic locally advanced tumours [ 4 ].…”