Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer: Preliminary study for a multicenter prospective KLASS07 trial.

Hyui Eun Jin, Min Seo Kim, Chang Min Lee, Ji Ho Park, Chang In Choi, Han Hong Lee, Jae-Seok Min, Ye Seob Jee, Jeong Oh, Hyundong Chae, Sung-Il Choi, Yoon Taek Lee, Jong-Han Kim, Hua Huang, Sungsoo Park

Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2020;45(12):2231-2240

PMID: 31262598

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications.

METHODS

PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.).

RESULTS

Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference.

CONCLUSIONS

TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).

Address: Korea University College of Medicine, Seoul, South Korea.; Department of Surgery, Korea University College of Medicine, Seoul, South Korea.; Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea.; Department of Surgery, Pusan National University College of Medicine, Pusan, South Korea.; Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.; Department of Surgery, Dongnam Institute of Radiological & Medical Science, Pusan, South Korea.; Department of Surgery, Dankook University College of Medicine, Cheonan, South Korea.; Department of Surgery, Chonnam National University College of Medicine, Gwangju, South Korea.; Department of Surgery, Daegu Catholic University School of Medicine, Daegu, South Korea.; Department of Surgery, Kyung Hee University College of Medicine, Seoul, South Korea.; Department of Gastric Surgery, Shanghai Medical College of Fudan University, Shanghai, China.; Department of Surgery, Korea University College of Medicine, Seoul, South Korea. Electronic address: [email protected].

DOI: 10.1016/j.ejso.2019.06.030

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MeSH Terms: Gastrectomy, Humans, Laparoscopy, Pain Measurement, Pain, Postoperative, Postoperative Complications, Stomach Neoplasms