Grzegorz Torbicz, Natalia Gajewska, Magdalena Mizera, Nadia Sajuk, Kamil Rozmus, Jan Witowski, Piotr Malczak, MD, Piotr Major, MD, PhD, Michal Pedziwiatr, MD, PhD. 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
Introduction: This study aimed to evaluate short-term outcomes of laparoscopic approach in comparison to open surgery in gastric cancer through systematic review with meta-analysis. Worldwide stomach cancer remains the fifth most common cancer. Now, the open approach is a gold standard of treatment gastric cancer, because provide to radical resection with appropriate lymphadenectomy. On the other hand, the effectiveness of minimally invasive techniques, such as laparoscopy or robotic procedures, has been confirmed in gastric oncological surgery. The literature comparing laparoscopic vs. open approach in total gastrectomy with lymphadenectomy D2 is sparse and usually focused on Asian population.
Material and Methods: The Medline, Embase and Cochrane databases were searched to identify eligible studies. The inclusion criteria are: gastric cancer, total gastrectomy D2, total laparoscopic vs open surgery, paper in English. The outcomes of interest involved morbidity, harvested lymph nodes, operative time, R0 rate and length of hospital stay. Articles lacking comparative data on overall morbidity outcomes, focusing on procedures other than total gastrectomy D2 or if extraction of data was not possible, were excluded. All references were reviewed and evaluated by two teams of two researchers. In case of any doubts about eligibility for inclusion, an attempt was made to reach consensus within the group. Data from included studies were extracted independently by all teams. The analysis was performed using RevMan 5.3 software.
Results: 8 eligible studies were included, with a total of 1,582 patients. The higher postoperative complications were in open group (RR 0.67, 95%CI [0.51, 0.86]). The length of hospital stay was shorter in lap group (MD -2.45, 95%CI [-3.66, -1.24]). There were no differences in operative time (p=0.68), harvested lymph nodes (p=0.91) and R0 rate (p=0.88).
Conclusion: Our meta-analysis confirms that laparoscopic total gastrectomy D2 in gastric cancer had better results than open approach in the case of postoperative complications and length of hospital stay.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93936
Program Number: P616
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster