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.