Meta-analysis Of Laparoscopic Versus Open Surgery For Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Objective:To conduct a meta-analysis evaluating the short-term results and long-term prognosis of laparoscopic and open surgery for advanced gastric cancer after neoadjuvant chemotherapy.Methods:The literatures in Pub Med,Cochrane Library,Embase,CNKI and Wanfang Medical Network were searched by computer,and the search ended on August 1,2021.According to inclusion and exclusion criteria,the literature was screened and the relevant data was extracted.Meta-analysis was performed using Rev Man V5.3.Results:Ten studies with a total of 961 patients(379 patients in the laparoscopic group and 582 patients in the open group)were included in this study.The laparoscopic group had less intraoperative blood loss(MD=-64.78,95% CI=-100.19 ～-29.37,P=0.0003),and there was no significant difference between the two groups in the number of lymph nodes dissected during operation(MD=-0.50,95% CI=-2.65 ～ 1.66,P=0.65).The laparoscopic group had earlier postoperative exhaust(MD=-0.34,95% CI=-0.59 ～-0.08,P=0.009),and the postoperative hospital stay was shorter(MD=-1.85,95% CI=-3.32 ～-0.39,P=0.01),but the operative time was longer(MD= 30.37,95% CI= 25.25 ～ 35.48,P<0.00001).There was no significant difference between the two groups in the incidence of surgical complications after operation(OR= 0.78,95% CI= 0.53 ～ 1.13,P=0.19),the time of first defecation(MD= 0.00,95% CI=-0.10 ～ 0.10,P=0.98)and the time of first postoperative feeding(MD=-0.02,95% CI=-0.11 ～ 0.08,P=0.73).As for long-term postoperative prognosis,there was no significant difference between the two groups in 3-year overall survival rate(OR= 1.06,95% CI= 0.40 ～ 2.83,P=0.90)and 5-year overall survival rate(OR= 1.26,95% CI= 0.46 ～ 3.43,P=0.66).Conclusion:The application of laparoscopic technique in advanced gastric cancer after neoadjuvant chemotherapy has good clinical efficacy and safety,and has no adverse effect on the long-term prognosis of patients.