Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis  

作　　者：Song Wang Mei-Lan Su Yang Liu Zhi-Ping Huang Ning Guo Tian-Jin Chen Zhong-Hui Zou 

机构地区：[1]Department of Stomach/Thyroid/Vascular Surgery,Chongqing Three Gorges Central Hospital,Chongqing 404000,China [2]Department of Psychosomatic Medicine,Chongqing Three Gorges Central Hospital,Chongqing 404000,China

出　　处：《World Journal of Clinical Cases》2020年第5期900-911,共12页世界临床病例杂志

基　　金：Supported by the Ethics Committee of Chongqing Three Gorges Central Hospital;the Guiding Project of Science and Technology Plan for Social Development in Wanzhou District Chongqing,No.wzstc-z 201707

摘　　要：BACKGROUND Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric cancer.The main difference between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)is the route of digestive tract reconstruction.However,TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is uncertain.AIM To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer,and to determine the safety and feasibility of intracorporeal esophagojejunostomy.METHODS PubMed,EMBASE,and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,2019.Inclusion and exclusion criteria were established.All the basic conditions of patients and important clinical data related to surgery were extracted,and a meta-analysis was performed with RevMan 5.3 software.RESULTS Eight studies involving a total of 1883 cases(869 cases in the TLTG group and 1014 cases in the LATG group)were included.Compared with the LATG group,reduced intraoperative blood loss(weighted mean difference=-35.37,95%CI:-61.69--9.06,P=0.008)and a larger number of retrieved lymph nodes(weighted mean difference=3.11,95%CI:-2.60-12.00,P=0.01)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(P>0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and feasible.TLTG has the advantages of being minimally invasive,reduced intraoperative blood loss and easier access to lymph nodes compared with LATG.Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.BACKGROUND Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric cancer. The main difference between totally laparoscopic total gastrectomy(TLTG) and laparoscopic-assisted total gastrectomy(LATG) is the route of digestive tract reconstruction. However, TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is uncertain.AIM To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer, and to determine the safety and feasibility of intracorporeal esophagojejunostomy.METHODS Pub Med, EMBASE, and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,2019. Inclusion and exclusion criteria were established. All the basic conditions of patients and important clinical data related to surgery were extracted, and a meta-analysis was performed with Rev Man 5.3 software.RESULTS Eight studies involving a total of 1883 cases(869 cases in the TLTG group and1014 cases in the LATG group) were included. Compared with the LATG group,reduced intraoperative blood loss(weighted mean difference =-35.37, 95%CI:-61.69--9.06, P = 0.008) and a larger number of retrieved lymph nodes(weighted mean difference = 3.11, 95%CI:-2.60-12.00, P = 0.01) 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(P > 0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and feasible. TLTG has the advantages of being minimally invasive, reduced intraoperative blood loss and easier access to lymph nodes compared with LATG. Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.

关 键 词：Gastric cancer Total gastrectomy ESOPHAGOJEJUNOSTOMY Totally laparoscopic LAPAROSCOPIC-ASSISTED META-ANALYSIS 

分 类 号：R735.2[医药卫生—肿瘤]