Meta-Analysis
Copyright ©2013 Baishideng Publishing Group Co.
World J Gastroenterol. Nov 28, 2013; 19(44): 8114-8132
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8114
Table 1 Study characteristics
Author, yearCountryStudy designGroupNo. of patientsAge(yr)Gender(M/F)BMI(kg/m2)ASA (1:2:3)Tumorsize (cm)Tumor stage1Extent of LNDPopulation
Dulucq et al[28], 2005FrancePCSLTG875 ± 83/5NANA5.5 ± 2NAD1 + βEGC + AGC
OTG1167 ± 145/6NANA6.1 ± 0.4NA
Usui et al[9], 2005JapanRCSLTG2066.0 ± 10.413/721.3 ± 3.1NANA8/10/2/0/0D1 + βEGC + AGC
OTG1966.2 ± 10.214/522.1 ± 2.4NANA10/8/1/0/0
Kim et al[34], 2008South KoreaRCSLTG2757.3 ± 14.216/1122.6 ± 3.1NANANAD1 + α/β, D2EGC + AGC
OTG3361.6 ± 9.223/1022.4 ± 2.1NANANA
Mochiki et al[15], 2008JapanRCSLTG2066 ± 2.416/4NANA3.6 ± 0.5NAD1 + βEGC
OTG1863 ± 2.216/2NANA5.7 ± 0.8NA
Topal et al[14], 2008BelgiumPCSLTG3868 (37-85)23/1524 (17-30)NA47 (7-180)0/17/7/10/4D2EGC + AGC
OTG2269 (38-86)17/524 (17-30)NA30 (10-180)0/7/7/6/2
Kawamura et al[30], 2009JapanRCSLTG4664 ± 10.410/3622.8 ± 3.015/27/4NANAD2EGC
OTG3565.2 ± 10.710/2522.9 ± 2.414/15/6NANA
Sakuramoto et al[16], 2009JapanRCSLTG3063.7 ± 9.212/1821.9 ± 2.79/20/14.0 ± 2.90/25/2/3/0D1 + β, D2EGC + AGC
OTG4467.2 ± 9.910/3422.5 ± 3.68/28/86.1 ± 3.70/15/17/12/0
Du et al[27], 2010ChinaRCSLTG8260.4 ± 18.554/2822.3 ± 2.6NA5.4 ± 1.40/3/36/43/0D2AGC
OTG9457.8 ± 17.261/3322.5 ± 2.4NA5.9 ± 1.60/6/31/57/0
Kim et al[33], 2011South KoreaRCSLTG6355.9 ± 12.243/2022.7 ± 2.545/15/33.8 ± 2.1NAD2EGC
OTG12757.3 ± 11.181/4623.0 ± 2.986/39/23.9 ± 2.7NA
Eom et al[10], 2012South KoreaRCSLTG10054.9 ± 13.557/4322.7 ± 2.8NA4.3 ± 2.9NAD1 + β, D2EGC + AGC
OTG34858.7 ± 11.5254/9423.8 ± 2.9NA4.4 ± 3.0NA
Guan et al[17], 2012ChinaRCSLTG4160.7 ± 9.133/8NANANA0/18/20/3/0D2EGC + AGC
OTG5657.8 ± 9.940/16NANANA0/25/25/6/0
Siani et al[38], 2012ItalyRCSLTG2565 ± 8.515/10NANANA0/6/5/14/0D1 + α/β, D2EGC + AGC
OTG2566 ± 7.818/7NANANA0/4/5/16/0
Kim et al[32], 2013South KoreaRCSLTG13958 (30-84)86/5323.6 (13.6-32.4)85/46/83.2 (0.2, 15)NAD2EGC + AGC
OTG20756 (31-84)134/7324.1 (16.7-35.2)137/52/184.0 (0.3, 22)NA
Jeong et al[29], 2013South KoreaRCSLTG12263.2 ± 11.289/3323.1 ± 3.433/80/9NANAD1 + β, D2EGC + AGC
OTG12262.6 ± 11.793/2923.5 ± 3.243/67/12NANA
Lee et al[37], 2013South KoreaRCSLTG5050.6 ± 22.132/1823.2 ± 3.734/11/5NA0/24/13/9/4D2EGC + AGC
OTG5051 ± 22.632/1823 ± 3.431/16/3NA0/24/13/9/4
Table 2 Quality assessment scoring of included studies, according to NOS criterion
Author, yearSelectionComparability1Outcome assessmentStar Score
1234567
Dulucq et al[28], 2005************
Usui et al[9], 2005**********
Kim et al[34], 2008********
Mochiki et al[15], 2008************
Topal et al[14], 2008****************
Kawamura et al[30], 2009****************
Sakuramoto et al[16], 2009**************
Du et al[27], 2010**************
Kim et al[33], 2011**************
Eom et al[10], 2012**********
Guan et al[17], 2012**********
Siani et al[38], 2012**************
Kim et al[32], 2013************
Jeong et al[29], 2013**************
Lee et al[37], 2013****************
Table 3 Perioperative outcomes
Author, yearGroupOperation time (min)Intraoperative blood loss (mL)No. of resected lymph nodes(n)Time to first flatus (d)Time to first oral intake(d)Hospital stay(d)Analgesics use (times)Postoperative complications (%)In-hospitalMortality (%)
Dulucq et al[28], 2005LTG183 ± 4881 ± 10724 ± 123.6 ± 1.2NA16.9 ± 3NA00
OTG165 ± 60125 ± 9520 ± 84.7 ± 1.2NA24 ± 9NA189
Usui et al[9], 2005LTG280.1 ± 45.2227.5 ± 148.128.0 ± 15.12.9 ± 0.95.7 ± 2.115.5 ± 3.92.1 ± 1.3NANA
OTG266.4 ± 48.2393.1 ± 173.628.9 ± 14.34.2 ± 1.48.8 ± 1.323.2 ± 4.63.4 ± 4.4NANA
Kim et al[34], 2008LTG527.5 ± 95.7NA27.2 ± 15.73.6 ± 0.9NA16.2 ± 7.1NA7.40
OTG320.9 ± 75.8NA37.2 ± 15.74.1 ± 1.3NA16.0 ± 9.3NA24.20
Mochiki et al[15], 2008LTG254 ± 10299 ± 5026 ± 3NANA19 ± 3NA250
OTG248 ± 12758 ± 7835 ± 4NANA29 ± 3NA16.70
Topal et al[14], 2008LTG187 ± 6010.0 ± 98.8NANANANANA39.52.6
OTG152.5 ± 25450.0 ± 337.5NANANANANA40.94.5
Kawamura et al[30], 2009LTG291.9 ± 59.454.9 ± 45.348.5 ± 16.34.1 ± 1.0NA15.5 ± 3.36.9 ± 5.68.70
OTG272.1 ± 76.8304.3 ± 237.347.1 ± 21.54.3 ± 1.3NA18.8 ± 6.34.0 ± 3.222.90
Sakuramoto et al[16], 2009LTG313 ± 81134 ± 9843.2 ± 17.22.4 ± 1.14.9 ± 1.113.5 ± 2.76.8 ± 6.416.70
OTG218 ± 53407 ± 27051.2 ± 22.13.3 ± 1.06.0 ± 2.118.2 ± 9.611.8 ± 11.027.30
Du et al[27], 2010LTG275 ± 78156 ± 11234.2 ± 13.53.5 ± 0.83.5 ± 0.8NANA9.80
OTG212 ± 51339 ± 16236.4 ± 19.15.3 ± 1.35.3 ± 1.3NANA24.52.1
Kim et al[33], 2011LTG150.8 ± 31.2179.7 ± 123.838.7 ± 15.73.3 ± 0.74.3 ± 1.78.1 ± 3.85.3 ± 4.912.70
OTG131.2 ± 21.6272.7 ± 209.635.6 ± 13.13.8 ± 0.85.6 ± 4.49.6 ± 5.33.6 ± 3.918.90
Eom et al[10], 2012LTG283.7 ± 84.1NA48.3 ± 16.4NANA12.6 ± 15.5NA271
OTG198.5 ± 59.7NA49.8 ± 18.4NANA14.3 ± 16.7NA23.60.9
Guan et al[17], 2012LTG235.7 ± 38.5104.2 ± 42.923.1 ± 8.03 ± 0.72.2 ± 0.99.7 ± 2.2NA4.90
OTG211.5 ± 33.2355.6 ± 51.324.2 ± 7.53.3 ± 0.43.1 ± 0.513.6 ± 3.6NA5.40
Siani et al[38], 2012LTG211 ± 23250 ± 15035 ± 182.1 ± 0.9NA10.5 ± 1.5NA160
OTG185 ± 19495 ± 19040 ± 164.1 ± 1.5NA14.5 ± 3.1NA40
Kim et al[32], 2013LTG144 ± 104.3NA37 ± 243 ± 23 ± 12.37 ± 19.33 ± 24.5100
OTG137 ± 105NA34 ± 18.84 ± 2.35 ± 108 ± 94 ± 9.321.70
Jeong et al[29], 2013LTG289 ± 89249 ± 20442 ± 152.9 ± 0.83.9 ± 4.411.8 ± 11.8NA23.81.6
OTG203 ± 78209 ± 15746 ± 173.0 ± 0.83.6 ± 3.310.8 ± 7.0NA17.20.9
Lee et al[37], 2013LTG258 ± 54167.3 ± 135.248.4 ± 18.44 ± 1.25 ± 1.79.3 ± 4.2NA240
OTG198 ± 57178.4 ± 10754.3 ± 20.54.5 ± 1.56.1 ± 2.511.7 ± 7.3NA320
Table 4 Results of meta-analysis comparing laparoscopic total gastrectomy vs open total gastrectomy
Outcome of interestNo. of studiesNo. of patientsOR/WMD95%CIP valueHeterogeneity P valueI2
Operative outcomes
Operation time (min)15202248.2531.15-65.35< 0.00001< 0.0000193%
Intraoperative blood loss (mL)121168-201.19-296.50--105.87< 0.0001< 0.0000198%
Postoperative recovery
Time to first flatus (d)121412-0.82-1.18--0.45< 0.0001< 0.0000190%
Time to first oral intake (d)81266-1.3-1.84--0.75< 0.00001< 0.0000182%
Hospital stay (d)131786-3.55-5.13--1.96< 0.0001< 0.0000186%
Analgesics use (times)5730-0.09-2.39-2.200.940.000879%
Postoperative complications
Overall complication1419830.730.57-0.920.0090.0837%
Anastomotic leakage1419831.60.88-2.910.120.680%
Anastomotic stenosis1319231.220.68-2.210.500.950%
Ileus1319231.260.69-2.300.460.850%
Bleeding1319231.420.70-2.870.330.2623%
Abdominal abscess1319230.530.28-1.030.060.378%
Wound problems1319230.390.21-0.720.0020.750%
Oncological outcomes
Positive resection margins56980.570.03-9.550.69--
No. of resected lymph nodes141962-2.49-5.18-0.210.07< 0.0000174%
Proximal resection margin (cm)41160-0.26-0.54-0.010.060.650%
Distal resection margin (cm)411600.32-0.05-0.680.090.2232%