Laparoscopy-assisted Versus Open Distal Gastrectomy For Early Gastric Cancer

Objective: This study aims to answer the superiority of comparing laparoscopy-assisted distal gastrectomy(LADG) with open distal gastrectomy(ODG) in the treatment early gastric cancer(EGC).Material and Methods: A comprehensive search from inception up to May, 2014 was conducted on PubMed, Web of science, the Cochrane Library, CNKI, CBM and WanFang database. According to the established inclusion criteria and exclusion criteria, all eligible studies comparing LADG versus ODG were included, quality assessment was done on each trial and relevant data were extracted from qualified trials. Data synthesis and statistical analysis were performed using RevMan 5.2 software.Results: Seven randomized controlled trials(RCTs) totaling 390 patients(195 LADG and 195ODG) were analyzed. Compared to ODG, LADG showed longer operative time( WMD = 79.60;95% CI= 59.86 to 99.35; P < 0.00001), but was associated with less blood loss( WMD =-108.11;95% CI=-145.97 to-70.26; P < 0.00001), fewer administered analgesics( WMD=-1.70; 95%CI=- 2.19 to-1.22; P < 0.00001), fewer number of harvested lymph node( WMD=-2.77; 95%CI=-4.38 to-1.16; P =0.0007), lower incidence of postoperative complications( OR=0.26; 95%CI= 0.13 to 0.54; P = 0.0003), shorter postoperative hospital stay( WMD=-1.0; 95% CI=-1.83to-0.16; P =0.02) and earlier passage of flatus( WMD =-0.62; 95% CI=-0.96 to-0.27; P =0.0005).Conclusion: This meta-analysis demonstrates that LADG significantly reduces blood loss,decreased frequency of analgesic administration, faster recovery, a shorter hospital stay and fewer postoperative complications compared with ODG, though at the price of longer operative times and the number of harvested lymph nodes lesser as compared to ODG.