Systematic Review and Meta-analysis of Totally Laparoscopic and Laparoscopic Assisted Distal Gastrectomy for Gastric Cancer

Ke Chen, Yucheng Zhou, Yiping Mou, MD, FACS, Xiaowu Xu, MD, Yu Pan, Di Wu, Renchao Zhang, MD. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University

Objective: To compare the safety and minimally invasive effect of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic assisted distal gastrectomy (LADG) for gastric cancer by meta-analysis.

Methods: The literature databases before September 2014 were extensively searched to retrieve the comparative studies of TLDG and LADG with a relevance of study goal. The data of operation time, blood loss, time to flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity, pain score and the level of C-reactive protein (CRP) were analyzed. The statistical analysis was performed by RevMan 5.1 software.

Results: There are seven studies meeting the inclusion criteria for meta-analysis. A total of 1738 cases with gastric cancer, of whom 727 underwent TLDG and 1056 underwent LADG, were included in this meta-analysis. Comparing with LADG, TLDG experienced less blood loss [weighted mean difference (WMD) = 22.86 ml, 95% confidence interval (CI): 12.00 ~ 33.72, P < 0.01)], less times of analgesic requirement (WMD = 0.58, 95% CI: 0.35 ~ 0.81, P < 0.01), less pain score on postoperative day 1 and day 3 (day1: WMD = 0.60, 95% CI: 0.20 ~ 0.99, P < 0.01; day3: WMD = 0.36, 95% CI: 0.24 ~ 0.48, P < 0.01), earlier time to first oral intake (WMD = 0.66 d, 95% CI: 0.13 ~ 1.19, P = 0.01). The operation time, postoperative hospital stay, overall morbidity and anastomosis-related morbidity were similar between these two groups.

Conclusions: TLDG is a safe and feasible procedure. It has several advantages over LADG including less blood loss, less pain, quicker recovery and lower inflammatory response in the early stage after surgery.

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