Laparoscopic Gastric Cancer Surgery And Open Surgery Oncology Effects Meta-analysis

BACKGROUND:As the core technique of the minimal-invasive surgery, laparoscopic resection has become increasingly popular for the management of gastrointestinal tumor. In the past twenty years, many trails have been conducted to confirm its short-term outcomes and less complications as well. Due to the learning curves, the safety and radical efficacy remains to be established. This report compares the oncologic outcomes in patients with gastric cancer undergoing laparoscopic vs. open gastric surgery.METHODS:Using a defined search strategy through the database of MEDLlNE, EMBASE, OVID and Cochrane from 1990 to 2008, studies directly comparing LG (laparoscopic gastrectomy) with OG (open gastrectomy) for gastric cancer were identified. Eight studies were selected via the inclusion criteria, including 197 patients who underwent LG, while 191 patients underwent OG. Variables of interest were survival, recurrence rates, margin status and nodal retrieval. A meta-analysis was performed to assess the difference in oncologic outcomes between the two treatment approaches.RESULTS:There was no difference in margin positivity between the two groups (OR:0.37 (0.01,9.62), p=0.55). Neither were tumor recurrence rate and lymph node metastasis (p=0.94 and 0.73, respectively). Lymph nodes harvest was less in LG group than that in OG group (p<0.001), average number in LG group is 32.50, while in OG group is 35.05. Cancer related mortality at maximum follow-up was similar in both group (OR:0.65 (0.31,1.37),p=0.26). Port-site metastases and wound recurrences were rare and no differences were observed. Conclusion:1. The overall mortality in LG group is similar to that in OG group, and the disease-free survival rate was 57.3% and 54.8% respectively. There is no significant difference in analysis.2. Both teams acquire negative resection margins.3. Lymph nodes harvest was less in LG group than that in OG group, and the average number was above 30.4. The recurrence rate in LG group was 8.1%, while in OG group was 8.0%. Most of them were found in the advantage stage of gastric cancer, and were recurred in two years after the operation.5. No port-site metastasis and wound recurrence were found in this meta-analysis.Data gathered in this meta-analysis indicate that there are no oncologic differences between laparoscopic and open resections for treatment of gastric cancer. LG is a safe, effective alternative to conventional surgery for the treatment of potentially curative gastric cancer.