Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.900
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
Laparoscopic total gastrectomy for gastric cancer includes laparoscopic-assisted total gastrectomy (LATG) and totally laparoscopic total gastrectomy (TLTG). The main difference between LATG and TLTG is the route of digestive tract reconstruction. Needless to say, TLTG has the advantage of being more minimally invasive when compared with LATG. However, TLTG has not yet been promoted, mainly because the safety and feasibility of intracorporeal esophagojejunostomy of TLTG have not been determined.
If the safety and feasibility of intracorporeal esophagojejunostomy of TLTG for gastric cancer can be confirmed, TLTG may be more widely used in clinical practice due to its unique advantages.
The present meta-analysis was performed to compare the short-term efficacy of TLTG and LATG for gastric cancer, and investigate the safety and feasibility of totally laparoscopic esophagojejunostomy in order to obtain the best evidence to guide clinical practice.
We collected high-quality published articles on TLTG vs LATG for gastric cancer via English language databases (such as PubMed, EMBASE, and Web of Science). All the basic conditions of patients (e.g. the first author, nationality, publication time, sample size, age, body mass index) and important clinical data related to surgery (e.g. the operating time, anastomotic time, intraoperative blood loss, tumor size, proximal resection margin length, number of retrieved lymph nodes, postoperative pain score, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative anastomosis-related complication rate and overall complication rate) were extracted. A comprehensive and detailed comparison of two surgical approaches (TLTG vs LATG) for gastric cancer was performed by meta-analysis to explore the efficacy differences.
Compared with the LATG group, reduced intraoperative blood loss and a larger number of retrieved lymph nodes 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.
We confirmed the clinical safety and feasibility of TLTG for gastric cancer, and TLTG has the advantages of being minimally invasive, reduced intraoperative blood loss and easier access to lymph nodes compared to LATG.
We speculate that totally laparoscopic radical gastrectomy for gastric cancer is likely to be the surgical trend for gastric cancer in the future.