Objective: To evaluate the safety and efficacy of laparoscopic-assisted distal gastrectomy (LADG) for gastric cancer through a meta-analysis of LADG versus open distal gastrectomy(ODG).
Methods: Comparative studies of LADG and ODG wer collected from Pubmed, Cochrane library, Web of Science and Biosis Previews Databases between January 1995 and October 2012. The data of operative duration, blood loss volume, number of harvested lymph node, proximal and distal resection margins, time to flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity and 5-year survival rate were analyzed. And statistical analysis was performed with RevMan 5.1 software.
Results: A total of 16 articles were analyzed. There were 4 randomized controlled trials and 12 retrospective observational reports. Among a total of 2854 patients with gastric cancer, 1441 LADG and 1413 ODG subjects were included. Compared with ODG, LADG resulted in significantly prolonged operative duration (weighted mean difference (WMD) = 49.09 min, P < 0.01), less blood loss volume(WMD = -118.99 ml, P < 0.01), less time to flatus (WMD = -0.58 d, P < 0.01) and oral intake (WMD = -0.61 d, P < 0.01), shortened postoperative hospital stay (WMD = -2.48 d, P < 0.01) and less postoperative morbidity (relative risk (RR) = 0.62, P < 0.01). Distal resection margin did not differ significantly between LADG and ODG (WMD = -0.01 cm, P = 0.94) while proximal resection margin was significantly shorter in the LADG group (WMD = -0.83 cm, P < 0.01). The number of harvested lymph node was significantly lesser in the LADG group than that in ODG group (WMD = -2.17, P = 0.05). However, no significant difference existed when only analyzing the papers published over the last 5 years or having over 50 LADG cases (all P > 0.05). Furthermore, the 5-year survival rate did not differ significantly between two groups (RR = 1.02, P = 0.52).
Conclusion: As a safe and practical procedure with less blood loss volume, fewer overall complications and a quicker recovery, LADG may offer satisfactory long-term outcomes comparable to those of conventional open surgery.