Three-dimensional vs 2-dimensional laparoscopic gastrectomy for gastric cancer A systematic review and meta-analysis

Background: Both 3-dimensional (3D) laparoscopic gastrectomy (LG) and 2-dimensional (2D) LG are commonly used for gastric cancer (GC). To investigate their safety and efficacy, we performed this meta-analysis. Methods: PubMed, The Cochrane Library, Science Direct, Embase, Scopus, and Web of Science were systematically searched to identify relevant studies. The total number of lymph node dissections (LNDs), operation time, blood loss, postoperative hospital stay, postoperative complications, and hospitalization cost were extracted as major endpoints. Results: Among 904 articles that were enrolled, 9 studies were included for analysis. The 3D group was observed to have shorter operation times [95% confidence interval (CI): -0.54 to -0.06; P=.01] and less blood loss (95% CI: -0.41 to -0.19; P<.00001) than the 2D group. Compared with the 2D group, slightly higher hospitalization cost was found in the 3D group (95% CI: 0.06-0.37; P=.008). However, the outcomes among the total LNDs, postoperative hospital stay, and postoperative complications were similar. Subgroup analysis suggested that the 3D LG group had more 11p (2.22 +/- 1.80 vs 1.47 +/- 1.99, P=.019) and 8a (2.52 +/- 1.88 vs 1.48 +/- 1.43, P=.001) LNDs compared to the 2D LG group. Conclusions: 3D LG has advantages for GC, with shorter operation times, less blood loss, and possibly more LNDs. However, the cost was slightly higher than that of 2D LG.