Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma

Memon, Muhammed Ashraf, Khan, Shahjahan, Yunus, Rossita Mohamad, Barr, Richard and Memon, Breda (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surgical Endoscopy and Other Interventional Techniques, 22 8: 1781-1789. doi:10.1007/s00464-008-9925-9

Author Memon, Muhammed Ashraf
Khan, Shahjahan
Yunus, Rossita Mohamad
Barr, Richard
Memon, Breda
Title Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma
Journal name Surgical Endoscopy and Other Interventional Techniques   Check publisher's open access policy
ISSN 1866-6817
Publication date 2008-08
Sub-type Article (original research)
DOI 10.1007/s00464-008-9925-9
Volume 22
Issue 8
Start page 1781
End page 1789
Total pages 9
Place of publication New York, NY, United States
Publisher Springer New York
Language eng
Formatted abstract
Objectives: The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic assisted (LADG) and open (ODG) distal gastrectomy for proven gastric cancer.

Data sources and review methods: A search of the Medline, Embase, Science Citation Index, Current Contents, and PubMed databases identified all randomized clinical trials (RCTs) that compared LADG and OGD and were published in the English language between January 1990 and the end of June 2007. The meta-analysis was prepared in accordance with the Quality of Reporting of Metaanalyses (QUOROM) statement. The eight outcome variables analysed were operating time, blood loss, retrieval of lymph nodes, oral intake, hospital stay, postoperative complications, tumor recurrence, and mortality. Random effects meta-analyses were performed using odds ratios (OR) and weighted mean differences (WMD).

Results: Four trials were considered suitable for metaanalysis.A total of 82 patients underwent LADG and 80 had ODG. For only one of the eight outcomes, the summary point estimates favoured LADG over ODG; there was a significant reduction of 104.26 ml in intraoperative blood loss for LADG (WMD, -104.26, 95% confidence interval (CI) -189.01 to -19.51; p = 0.0159). There was however a 83.08 min longer duration of operating time for the LADG group compared with the ODG group (WMD 83.08, 95% CI 40.53 to 125.64; p = 0.0001) and significant reduction in lymph nodes harvesting of 4.34 lymph nodes in the LADG group (WMD -4.3, 95% CI -6.66 to -2.02; p = 0.0002). Other outcome variables such as time to commencement of oral intake (WMD -0.97, 95% CI - 2.47 to 0.54; p = 0.2068), duration of hospital stay (WMD -3.32, 95% CI -7.69 to 1.05; p = 0.1365), rate of complications (OR 0.66, 95% CI 0.27 to 1.60; p = 0.3530), mortality rates (OR 0.94, 95% CI 0.21 to 4.19; p = 0.9363), and tumor recurrence (OR 1.08, 95% CI 0.42 to 2.79; p = 0.8806) were not found to be statistically significant for either group. However, for commencement of oral intake, duration of hospital stay, and complication rate, the trend was in favor of LADG.

Conclusion: LADG was associated with a significantly reduced rate of intraoperative blood loss, at the expense of significantly longer operating time and significantly reduced lymph node retrieval compared to its open counterpart. Mortality and tumor recurrence rates were similar between the two groups. Furthermore, time to commencement of oral intake, postprocedural discharge from hospital, and perioperative complication rate, although not significantly different between the two groups, did suggest a positive trend toward LADG. Based on this meta-
analysis, the authors cannot recommend the routine use of LADG over ODG for the treatment of distal gastric cancer. However, significant limitations exist in the interpretation of this data due to the limited number of published randomised control trials, the small sample sizes to date, and the limited duration of follow up. Further large multicentre randomized controlled trials are required to delineate significantly quantifiable differences between the two groups.
Keyword Gastric cancer
Laparoscopic method
Comparative studies
Randomized controlled trials
Patient outcome
Intraoperative complications
Postoperative complications
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 96 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 03 Sep 2009, 09:46:59 EST by Mr Andrew Martlew on behalf of School of Medicine