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©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
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8114
Table 1 Study characteristics
Author, year | Country | Study design | Group | No. of patients | Age(yr) | Gender(M/F) | BMI(kg/m2) | ASA (1:2:3) | Tumorsize (cm) | Tumor stage1 | Extent of LND | Population |
Dulucq et al[28], 2005 | France | PCS | LTG | 8 | 75 ± 8 | 3/5 | NA | NA | 5.5 ± 2 | NA | D1 + β | EGC + AGC |
OTG | 11 | 67 ± 14 | 5/6 | NA | NA | 6.1 ± 0.4 | NA | |||||
Usui et al[9], 2005 | Japan | RCS | LTG | 20 | 66.0 ± 10.4 | 13/7 | 21.3 ± 3.1 | NA | NA | 8/10/2/0/0 | D1 + β | EGC + AGC |
OTG | 19 | 66.2 ± 10.2 | 14/5 | 22.1 ± 2.4 | NA | NA | 10/8/1/0/0 | |||||
Kim et al[34], 2008 | South Korea | RCS | LTG | 27 | 57.3 ± 14.2 | 16/11 | 22.6 ± 3.1 | NA | NA | NA | D1 + α/β, D2 | EGC + AGC |
OTG | 33 | 61.6 ± 9.2 | 23/10 | 22.4 ± 2.1 | NA | NA | NA | |||||
Mochiki et al[15], 2008 | Japan | RCS | LTG | 20 | 66 ± 2.4 | 16/4 | NA | NA | 3.6 ± 0.5 | NA | D1 + β | EGC |
OTG | 18 | 63 ± 2.2 | 16/2 | NA | NA | 5.7 ± 0.8 | NA | |||||
Topal et al[14], 2008 | Belgium | PCS | LTG | 38 | 68 (37-85) | 23/15 | 24 (17-30) | NA | 47 (7-180) | 0/17/7/10/4 | D2 | EGC + AGC |
OTG | 22 | 69 (38-86) | 17/5 | 24 (17-30) | NA | 30 (10-180) | 0/7/7/6/2 | |||||
Kawamura et al[30], 2009 | Japan | RCS | LTG | 46 | 64 ± 10.4 | 10/36 | 22.8 ± 3.0 | 15/27/4 | NA | NA | D2 | EGC |
OTG | 35 | 65.2 ± 10.7 | 10/25 | 22.9 ± 2.4 | 14/15/6 | NA | NA | |||||
Sakuramoto et al[16], 2009 | Japan | RCS | LTG | 30 | 63.7 ± 9.2 | 12/18 | 21.9 ± 2.7 | 9/20/1 | 4.0 ± 2.9 | 0/25/2/3/0 | D1 + β, D2 | EGC + AGC |
OTG | 44 | 67.2 ± 9.9 | 10/34 | 22.5 ± 3.6 | 8/28/8 | 6.1 ± 3.7 | 0/15/17/12/0 | |||||
Du et al[27], 2010 | China | RCS | LTG | 82 | 60.4 ± 18.5 | 54/28 | 22.3 ± 2.6 | NA | 5.4 ± 1.4 | 0/3/36/43/0 | D2 | AGC |
OTG | 94 | 57.8 ± 17.2 | 61/33 | 22.5 ± 2.4 | NA | 5.9 ± 1.6 | 0/6/31/57/0 | |||||
Kim et al[33], 2011 | South Korea | RCS | LTG | 63 | 55.9 ± 12.2 | 43/20 | 22.7 ± 2.5 | 45/15/3 | 3.8 ± 2.1 | NA | D2 | EGC |
OTG | 127 | 57.3 ± 11.1 | 81/46 | 23.0 ± 2.9 | 86/39/2 | 3.9 ± 2.7 | NA | |||||
Eom et al[10], 2012 | South Korea | RCS | LTG | 100 | 54.9 ± 13.5 | 57/43 | 22.7 ± 2.8 | NA | 4.3 ± 2.9 | NA | D1 + β, D2 | EGC + AGC |
OTG | 348 | 58.7 ± 11.5 | 254/94 | 23.8 ± 2.9 | NA | 4.4 ± 3.0 | NA | |||||
Guan et al[17], 2012 | China | RCS | LTG | 41 | 60.7 ± 9.1 | 33/8 | NA | NA | NA | 0/18/20/3/0 | D2 | EGC + AGC |
OTG | 56 | 57.8 ± 9.9 | 40/16 | NA | NA | NA | 0/25/25/6/0 | |||||
Siani et al[38], 2012 | Italy | RCS | LTG | 25 | 65 ± 8.5 | 15/10 | NA | NA | NA | 0/6/5/14/0 | D1 + α/β, D2 | EGC + AGC |
OTG | 25 | 66 ± 7.8 | 18/7 | NA | NA | NA | 0/4/5/16/0 | |||||
Kim et al[32], 2013 | South Korea | RCS | LTG | 139 | 58 (30-84) | 86/53 | 23.6 (13.6-32.4) | 85/46/8 | 3.2 (0.2, 15) | NA | D2 | EGC + AGC |
OTG | 207 | 56 (31-84) | 134/73 | 24.1 (16.7-35.2) | 137/52/18 | 4.0 (0.3, 22) | NA | |||||
Jeong et al[29], 2013 | South Korea | RCS | LTG | 122 | 63.2 ± 11.2 | 89/33 | 23.1 ± 3.4 | 33/80/9 | NA | NA | D1 + β, D2 | EGC + AGC |
OTG | 122 | 62.6 ± 11.7 | 93/29 | 23.5 ± 3.2 | 43/67/12 | NA | NA | |||||
Lee et al[37], 2013 | South Korea | RCS | LTG | 50 | 50.6 ± 22.1 | 32/18 | 23.2 ± 3.7 | 34/11/5 | NA | 0/24/13/9/4 | D2 | EGC + AGC |
OTG | 50 | 51 ± 22.6 | 32/18 | 23 ± 3.4 | 31/16/3 | NA | 0/24/13/9/4 |
Table 2 Quality assessment scoring of included studies, according to NOS criterion
Author, year | Selection | Comparability1 | Outcome assessment | Star Score | ||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | ||
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, year | Group | Operation 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], 2005 | LTG | 183 ± 48 | 81 ± 107 | 24 ± 12 | 3.6 ± 1.2 | NA | 16.9 ± 3 | NA | 0 | 0 |
OTG | 165 ± 60 | 125 ± 95 | 20 ± 8 | 4.7 ± 1.2 | NA | 24 ± 9 | NA | 18 | 9 | |
Usui et al[9], 2005 | LTG | 280.1 ± 45.2 | 227.5 ± 148.1 | 28.0 ± 15.1 | 2.9 ± 0.9 | 5.7 ± 2.1 | 15.5 ± 3.9 | 2.1 ± 1.3 | NA | NA |
OTG | 266.4 ± 48.2 | 393.1 ± 173.6 | 28.9 ± 14.3 | 4.2 ± 1.4 | 8.8 ± 1.3 | 23.2 ± 4.6 | 3.4 ± 4.4 | NA | NA | |
Kim et al[34], 2008 | LTG | 527.5 ± 95.7 | NA | 27.2 ± 15.7 | 3.6 ± 0.9 | NA | 16.2 ± 7.1 | NA | 7.4 | 0 |
OTG | 320.9 ± 75.8 | NA | 37.2 ± 15.7 | 4.1 ± 1.3 | NA | 16.0 ± 9.3 | NA | 24.2 | 0 | |
Mochiki et al[15], 2008 | LTG | 254 ± 10 | 299 ± 50 | 26 ± 3 | NA | NA | 19 ± 3 | NA | 25 | 0 |
OTG | 248 ± 12 | 758 ± 78 | 35 ± 4 | NA | NA | 29 ± 3 | NA | 16.7 | 0 | |
Topal et al[14], 2008 | LTG | 187 ± 60 | 10.0 ± 98.8 | NA | NA | NA | NA | NA | 39.5 | 2.6 |
OTG | 152.5 ± 25 | 450.0 ± 337.5 | NA | NA | NA | NA | NA | 40.9 | 4.5 | |
Kawamura et al[30], 2009 | LTG | 291.9 ± 59.4 | 54.9 ± 45.3 | 48.5 ± 16.3 | 4.1 ± 1.0 | NA | 15.5 ± 3.3 | 6.9 ± 5.6 | 8.7 | 0 |
OTG | 272.1 ± 76.8 | 304.3 ± 237.3 | 47.1 ± 21.5 | 4.3 ± 1.3 | NA | 18.8 ± 6.3 | 4.0 ± 3.2 | 22.9 | 0 | |
Sakuramoto et al[16], 2009 | LTG | 313 ± 81 | 134 ± 98 | 43.2 ± 17.2 | 2.4 ± 1.1 | 4.9 ± 1.1 | 13.5 ± 2.7 | 6.8 ± 6.4 | 16.7 | 0 |
OTG | 218 ± 53 | 407 ± 270 | 51.2 ± 22.1 | 3.3 ± 1.0 | 6.0 ± 2.1 | 18.2 ± 9.6 | 11.8 ± 11.0 | 27.3 | 0 | |
Du et al[27], 2010 | LTG | 275 ± 78 | 156 ± 112 | 34.2 ± 13.5 | 3.5 ± 0.8 | 3.5 ± 0.8 | NA | NA | 9.8 | 0 |
OTG | 212 ± 51 | 339 ± 162 | 36.4 ± 19.1 | 5.3 ± 1.3 | 5.3 ± 1.3 | NA | NA | 24.5 | 2.1 | |
Kim et al[33], 2011 | LTG | 150.8 ± 31.2 | 179.7 ± 123.8 | 38.7 ± 15.7 | 3.3 ± 0.7 | 4.3 ± 1.7 | 8.1 ± 3.8 | 5.3 ± 4.9 | 12.7 | 0 |
OTG | 131.2 ± 21.6 | 272.7 ± 209.6 | 35.6 ± 13.1 | 3.8 ± 0.8 | 5.6 ± 4.4 | 9.6 ± 5.3 | 3.6 ± 3.9 | 18.9 | 0 | |
Eom et al[10], 2012 | LTG | 283.7 ± 84.1 | NA | 48.3 ± 16.4 | NA | NA | 12.6 ± 15.5 | NA | 27 | 1 |
OTG | 198.5 ± 59.7 | NA | 49.8 ± 18.4 | NA | NA | 14.3 ± 16.7 | NA | 23.6 | 0.9 | |
Guan et al[17], 2012 | LTG | 235.7 ± 38.5 | 104.2 ± 42.9 | 23.1 ± 8.0 | 3 ± 0.7 | 2.2 ± 0.9 | 9.7 ± 2.2 | NA | 4.9 | 0 |
OTG | 211.5 ± 33.2 | 355.6 ± 51.3 | 24.2 ± 7.5 | 3.3 ± 0.4 | 3.1 ± 0.5 | 13.6 ± 3.6 | NA | 5.4 | 0 | |
Siani et al[38], 2012 | LTG | 211 ± 23 | 250 ± 150 | 35 ± 18 | 2.1 ± 0.9 | NA | 10.5 ± 1.5 | NA | 16 | 0 |
OTG | 185 ± 19 | 495 ± 190 | 40 ± 16 | 4.1 ± 1.5 | NA | 14.5 ± 3.1 | NA | 4 | 0 | |
Kim et al[32], 2013 | LTG | 144 ± 104.3 | NA | 37 ± 24 | 3 ± 2 | 3 ± 12.3 | 7 ± 19.3 | 3 ± 24.5 | 10 | 0 |
OTG | 137 ± 105 | NA | 34 ± 18.8 | 4 ± 2.3 | 5 ± 10 | 8 ± 9 | 4 ± 9.3 | 21.7 | 0 | |
Jeong et al[29], 2013 | LTG | 289 ± 89 | 249 ± 204 | 42 ± 15 | 2.9 ± 0.8 | 3.9 ± 4.4 | 11.8 ± 11.8 | NA | 23.8 | 1.6 |
OTG | 203 ± 78 | 209 ± 157 | 46 ± 17 | 3.0 ± 0.8 | 3.6 ± 3.3 | 10.8 ± 7.0 | NA | 17.2 | 0.9 | |
Lee et al[37], 2013 | LTG | 258 ± 54 | 167.3 ± 135.2 | 48.4 ± 18.4 | 4 ± 1.2 | 5 ± 1.7 | 9.3 ± 4.2 | NA | 24 | 0 |
OTG | 198 ± 57 | 178.4 ± 107 | 54.3 ± 20.5 | 4.5 ± 1.5 | 6.1 ± 2.5 | 11.7 ± 7.3 | NA | 32 | 0 |
Table 4 Results of meta-analysis comparing laparoscopic total gastrectomy vs open total gastrectomy
Outcome of interest | No. of studies | No. of patients | OR/WMD | 95%CI | P value | Heterogeneity P value | I2 |
Operative outcomes | |||||||
Operation time (min) | 15 | 2022 | 48.25 | 31.15-65.35 | < 0.00001 | < 0.00001 | 93% |
Intraoperative blood loss (mL) | 12 | 1168 | -201.19 | -296.50--105.87 | < 0.0001 | < 0.00001 | 98% |
Postoperative recovery | |||||||
Time to first flatus (d) | 12 | 1412 | -0.82 | -1.18--0.45 | < 0.0001 | < 0.00001 | 90% |
Time to first oral intake (d) | 8 | 1266 | -1.3 | -1.84--0.75 | < 0.00001 | < 0.00001 | 82% |
Hospital stay (d) | 13 | 1786 | -3.55 | -5.13--1.96 | < 0.0001 | < 0.00001 | 86% |
Analgesics use (times) | 5 | 730 | -0.09 | -2.39-2.20 | 0.94 | 0.0008 | 79% |
Postoperative complications | |||||||
Overall complication | 14 | 1983 | 0.73 | 0.57-0.92 | 0.009 | 0.08 | 37% |
Anastomotic leakage | 14 | 1983 | 1.6 | 0.88-2.91 | 0.12 | 0.68 | 0% |
Anastomotic stenosis | 13 | 1923 | 1.22 | 0.68-2.21 | 0.50 | 0.95 | 0% |
Ileus | 13 | 1923 | 1.26 | 0.69-2.30 | 0.46 | 0.85 | 0% |
Bleeding | 13 | 1923 | 1.42 | 0.70-2.87 | 0.33 | 0.26 | 23% |
Abdominal abscess | 13 | 1923 | 0.53 | 0.28-1.03 | 0.06 | 0.37 | 8% |
Wound problems | 13 | 1923 | 0.39 | 0.21-0.72 | 0.002 | 0.75 | 0% |
Oncological outcomes | |||||||
Positive resection margins | 5 | 698 | 0.57 | 0.03-9.55 | 0.69 | - | - |
No. of resected lymph nodes | 14 | 1962 | -2.49 | -5.18-0.21 | 0.07 | < 0.00001 | 74% |
Proximal resection margin (cm) | 4 | 1160 | -0.26 | -0.54-0.01 | 0.06 | 0.65 | 0% |
Distal resection margin (cm) | 4 | 1160 | 0.32 | -0.05-0.68 | 0.09 | 0.22 | 32% |
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Citation: Xiong JJ, Nunes QM, Huang W, Tan CL, Ke NW, Xie SM, Ran X, Zhang H, Chen YH, Liu XB. Laparoscopic
vs open total gastrectomy for gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19(44): 8114-8132 - URL: https://www.wjgnet.com/1007-9327/full/v19/i44/8114.htm
- DOI: https://dx.doi.org/10.3748/wjg.v19.i44.8114