Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 900-911
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.900
Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis
Song Wang, Mei-Lan Su, Yang Liu, Zhi-Ping Huang, Ning Guo, Tian-Jin Chen, Zhong-Hui Zou
Song Wang, Yang Liu, Zhi-Ping Huang, Ning Guo, Tian-Jin Chen, Zhong-Hui Zou, Department of Stomach/Thyroid/Vascular Surgery, Chongqing Three Gorges Central Hospital, Chongqing 404000, China
Mei-Lan Su, Department of Psychosomatic Medicine, Chongqing Three Gorges Central Hospital, Chongqing 404000, China
Author contributions: Wang S and Su ML contributed to the study design, data collection, and paper writing; Zou ZH contributed to the study design, and critical revision of the paper; Liu Y, Huang ZP, Guo N, and Chen TJ contributed to the data collection. All authors have approved the final version to be published.
Supported by the Ethics Committee of Chongqing Three Gorges Central Hospital, and the Guiding Project of Science and Technology Plan for Social Development in Wanzhou District Chongqing, No. wzstc-z 201707.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhong-Hui Zou, MA, Surgeon, Department of Stomach/Thyroid/Vascular Surgery, Chongqing Three Gorges Central Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing 404000, China. zouzhonghui97@163.com
Received: December 6, 2019
Peer-review started: December 6, 2019
First decision: December 30, 2019
Revised: February 18, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 6, 2020
Processing time: 90 Days and 19.5 Hours
Abstract
BACKGROUND

Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric cancer. The main difference between totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG) is the route of digestive tract reconstruction. However, TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is uncertain.

AIM

To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer, and to determine the safety and feasibility of intracorporeal esophagojejunostomy.

METHODS

PubMed, EMBASE, and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1, 2019. Inclusion and exclusion criteria were established. All the basic conditions of patients and important clinical data related to surgery were extracted, and a meta-analysis was performed with RevMan 5.3 software.

RESULTS

Eight studies involving a total of 1883 cases (869 cases in the TLTG group and 1014 cases in the LATG group) were included. Compared with the LATG group, reduced intraoperative blood loss (weighted mean difference = -35.37, 95%CI: -61.69 - -9.06, P = 0.008) and a larger number of retrieved lymph nodes (weighted mean difference = 3.11, 95%CI: -2.60 - 12.00, P = 0.01) were found in the TLTG group. There were no significant differences in operating time, anastomotic time, tumor size, proximal resection margin length, postoperative pain score, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative anastomosis-related complication rate and overall complication rate between the two groups (P > 0.05).

CONCLUSION

Intracorporeal esophagojejunostomy is safe and feasible. TLTG has the advantages of being minimally invasive, reduced intraoperative blood loss and easier access to lymph nodes compared with LATG. Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.

Keywords: Gastric cancer; Total gastrectomy; Esophagojejunostomy; Totally laparoscopic; Laparoscopic-assisted; Meta-analysis

Core tip: The safety and feasibility of intracorporeal esophagojejunostomy totally laparoscopic total gastrectomy (TLTG) are uncertain. We hypothesized that TLTG was safe and feasible, and the efficacy of TLTG was superior to that of laparoscopic-assisted total gastrectomy. A meta-analysis was performed to demonstrate this. The results showed that intracorporeal esophagojejunostomy is safe and feasible. TLTG has the advantages of being minimally invasive, reduced intraoperative blood loss and easier access to lymph nodes compared with laparoscopic-assisted total gastrectomy. Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.