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Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis

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Abstract

Background

The possible advantages of laparoscopic (assisted) total gastrectomy (LTG) versus open total gastrectomy (OTG) have not been reviewed systematically. The aim of this study was to systematically review the short-term outcomes of LTG versus OTG in the treatment of gastric cancer.

Methods

A systematic search of PubMed, Cochrane, CINAHL, and Embase was conducted. All original studies comparing LTG with OTG were included for critical appraisal. Data describing short-term outcomes were pooled and analyzed.

Results

A total of eight original studies that compared LTG (n = 314) with OTG (n = 384) in patients with gastric cancer fulfilled quality criteria and were selected for review and meta-analysis. LTG compared with OTG was associated with a significant reduction of intraoperative blood loss (weighted mean difference = 227.6 ml; 95 % CI 144.3–310.9; p < 0.001), a reduced risk of postoperative complications (risk ratio = 0.51; 95 % CI 0.33–0.77), and shorter hospital stay (weighted mean difference 4.0 = days; 95 % CI 1.4–6.5; p < 0.001). These benefits were at the cost of longer operative time (weighted mean difference = 55.5 min; 95 % CI 24.8–86.2; p < 0.001). In-hospital mortality rates were comparable for LTG (0.9 %) and OTG (1.8 %) (risk ratio = 0.68; 95 % CI 0.20–2.36).

Conclusion

LTG shows better short term outcomes compared with OTG in eligible patients with gastric cancer. Future studies should evaluate 30- and 60-day mortality, radicality of resection, and long-term follow-up in LTG versus OTG, preferably in randomized trials.

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Disclosures

L. Haverkamp, T. J. Weijs, P. C. van der Sluis, I. van der Tweel, J. P. Ruurda, and R. van Hillegersberg have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    Leonie Haverkamp, Teus J. Weijs, Pieter C. van der Sluis, Jelle P. Ruurda & Richard van Hillegersberg

  2. Department of Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Ingeborg van der Tweel

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  1. Leonie Haverkamp
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Correspondence to Jelle P. Ruurda.

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Haverkamp, L., Weijs, T.J., van der Sluis, P.C. et al. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27, 1509–1520 (2013). https://doi.org/10.1007/s00464-012-2661-1

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