Totally Laparoscopic Gastrectomy Versus Laparoscopic-Assisted Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis

Background:Totally laparoscopic gastrectomy (TLG) has recently been accepted as a treatment strategy for gastric cancer (GC). Aim:In this study, we conducted a meta-analysis to evaluate the safety and feasibility of TLG compared with laparoscopic-assisted gastrectomy (LAG) in GC. Methods:Feasible studies comparing the TLG and LAG published up to March 2019 were searched online. The data showing short-term and complication outcomes were extracted to be pooled and analyzed. Results:Thirty-four studies, including 7974 patients were eventually eligible. There was no statistically significant difference on operation time between the two groups (weighted mean difference [WMD] = 2.43, 95% confidence interval [CI]: -4.16 to 9.02,P = .47). The time of anvil insertion time was shorter in the TLG group compared with the LAG group (WMD = -1.87, 95% CI: -2.60 to -1.15,P < .01). The TLG was significantly superior to LAG in the comparison of less trauma. In terms of radical resection, the number of lymph nodes obtained by TLG was significantly more than that obtained by LAG (WMD = 2.65, 95% CI: 1.54-3.76,P < .01). The pooled meta-analysis suggested that the patients undergoing TLG had a quicker recovery and less pain. In the advanced gastric cancer gastrectomy, the TLG could receive a longer proximal margin compared with the LAG (WMD = 0.72, 95% CI: 0.48-0.95,P < .01). Regardless of the reconstruction method, the TLG was superior to the LAG in terms of surgical parameters and postoperative recovery. Like the LAG, the TLG was safe and advantageous. A lower risk trend of conversion to open laparotomy was observed in the TLG (relative risk [RR] = 0.72, 95% CI: 0.12-4.38,P = .72). The body mass index >25 kg/m(2)patients undergoing totally laparoscopic gastrectomy (TLGA) had a lower risk of overall complications (RR = 0.88, 95% CI: 0.48-1.63,P = .69). The patients with early gastric cancer or Billroth-I anastomosis were suitable to undergo the TLG (a lower risk of anastomotic leakage [RR = 0.01, 95% CI: 0.00-0.23,P < .01] and gastralgia [RR = 0.27, 95% CI: 0.08-0.88,P = .03], respectively). Conclusions:The TLG was a safe and reliable procedure compared with the LAG with reduced trauma, faster recovery, and not more complications.

Automated summary

Totally laparoscopic gastrectomy (TLG) shows better surgical advantages compared to laparoscopic-assisted gastrectomy (LAG) in the treatment of gastric cancer, including shorter operation time, more lymph nodes obtained, and quicker recovery.