Laparoscopic-Assisted Versus Open Radical Gastrectomy for Resectable Gastric Cancer: Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials

Background: Previous studies comparing laparoscopic-assisted to open gastrectomy (OG) for resectable gastric cancer were inexhaustive, so an updated meta-analysis was performed to clarify quality of life, patient satisfaction, safety and effectiveness associated with laparoscopic-assisted gastrectomy (LAG). Methods: Pubmed, Embase, and The Cochrane Library were searched from inception to December 2015 for randomized controlled trials (RCTs) comparing LAG with OG for resectable gastric cancer. Relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were pooled with random-effects model. Furthermore, trial sequential analysis (TSA) was employed to indicate the credibility of pooled estimate. Results: Fourteen RCTs totaling 2,307 gastric cancer patients (1,163 in laparoscopic and 1,144 in open) were included. Compared with OG, LAG showed higher patient satisfaction and quality of life, less blood loss, hospital stay and overall postoperative morbidity, and longer operating time, which were confirmed by TSA. LAG also accelerated time to first flatus, first walking and first intake and reduced frequency of analgesic administration and days of fever. There were no significant difference between the two groups in number of retrieved lymph nodes, mortality, recurrence, long-term overall survival and disease-free survival. Conclusion: For patients with resectable gastric cancer, LAG decreased blood loss, length of hospital stay and overall postoperative morbidity and improved postsurgical recovery. (C) 2016 Wiley Periodicals, Inc.