| Objective To assess the clinical effectiveness and safety of laparoscopic D2gastrectomy for advanced gastric cancer.Methods The databases such as the Chinese Journal Full-text Database, Chinese Scientific Journals Full-text Database, Chinese Biomedicine Database, Chinese Biomedical Literature Database, EMbase,PubMed, The Cochrane Library were searched by computer from the date of their establishment to June of2012, and the related literatures and conference proceedings were also manually searched to include randomized controlled trials(RCTs) on comparison of laparoscopic with conventional open resection for Advanced gastric cancer.Studyies were screened according to the inclusion and exclusion criteria,data were extracted, the methodological quality of the included studies was assessed according to Jadad score criterion,and meta-analyses were performed with RevMan5.1software.Results A total of17RCTs involving1944patients with advanced gastric cancer were enrolled. Comparing laparoscopic gastrectomy with conventional open surgery results showed longer surgery times[(weighted mean difference,WMD):43.59;(95%confidence interval,95%CI):27.22,59.96; P<0.00001],but less estimated blood loss (WMD:-111.05;95%CI:-146.02,-76.08; P<0.00001)、shorter durations of hospital stays (WMD:-2.20;95%CI:-2.82,-1.59; P<0.00001)、 earlier postoperative first flatus (WMD:-0.91;95%CI:-1.23,-0.59; P<0.00001)、less time to oral intake (WMD:-1.01;95%CI:-1.46,-0.56; P<0.00001).There is no significantly difference between laparoscopic gastrectomy group and conventional open surgery group in the number of lymph nodes dissected (WMD:-0.87;95%CI:-2.47,-0.73; P=0.28).Also,the postoperative complication rate was significantly lower with laparoscopic resection (OR:0.44;95%CI:0.31,0.63; P<0.00001)Conclusion The short-term outcome of laparoscopic D2gastrectomy for patients with advanced gastric cancer is superior to the conventional open surgery，but its long-term outcome should be proven by further outcomes of RCTs. |
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