Purpose: To conduct a systematic review to explore the role of laparoscopy for the management of gastric cancer. Methods: Randomized controlled trials were assessed when laparoscopy was utilized as an intervention. When utilized as a diagnostic test, trials were included if staging laparoscopy was compared to a predefined gold standard in addition to conventional staging modalities. Trials up to July 2007 were identified. Primary outcomes included oncologic factors, 5-year overall survival, 30-day survival and major peri-operative complication rates. Secondary outcomes assessed additional peri-operative outcomes. Two reviewers independently extracted data and assessed trial quality. The data were statistically combined if clinically and statistically reasonable. Results: Four randomized trials with 162 subjects met the inclusion criteria and compared laparoscopic versus open subtotal gastrectomy for gastric cancer. One trial reported that the 5-year overall survival [RR 0.97 (95% CI 0.70, 1.34)], recurrence rate [RR 1.06 (95% CI 0.53, 2.12)] and the number of subjects with at least a 5cm resection margin [RR 1.00 (95% CI 1.0, 1.0)] did not differ significantly between the two operative approaches. All subjects within the four trials had at least 15 lymph nodes retrieved. The combined 30-day survival data from three trials did not demonstrate a statistically significant difference [RR 1.04 (95% CI 0.92,1.17)]. The combined results from four trials noted a nonstatistically significant reduction in the number of major complications for laparoscopic subtotal gastrectomies compared to open [RR 0.41 (95% CI 0.12, 1.36)]. Five clinical trials with 1028 subjects met the inclusion criteria for assessing staging laparoscopy for gastric cancer. Overall, staging laparoscopy identified distant metastases that were not identified in a preoperative staging computed tomography for 20-30% of the subjects. Conclusion: There is some level I evidence for gastric cancer that demonstrates that a laparoscopic approach compared with open can achieve similar oncologic principles of surgery, long-term outcomes and survival and in addition may have a reduced risk of major peri-operative complications. There is evidence that staging laparoscopy is a more accurate staging modality than computed tomography for advanced gastric cancers.
Program Number: P255