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Journal of Zhejiang University SCIENCE B

, Volume 14, Issue 6, pp 468–478 | Cite as

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

  • Long-yun Ye
  • Da-ren Liu
  • Chao Li
  • Xiao-wen Li
  • Ling-na Huang
  • Sheng Ye
  • Yi-xiong Zheng
  • Li Chen
Article

Abstract

Objective

The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC).

Methods

Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model.

Results

Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI–2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05).

Conclusions

LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.

Key words

Gastric cancer Laparoscopic gastrectomy Meta-analysis Mortality Recurrence 

CLC number

R656.6+

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References

  1. Abraham, N.S., Byrne, C.J., Young, J.M., Solomon, M.J., 2010. Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials. J. Clin. Epidemiol., 63(3): 238–245. [doi:10.1016/j.jclinepi.2009.04.005]PubMedCrossRefGoogle Scholar
  2. Cai, J., Wei, D., Gao, C.F., Zhang, C.S., Zhang, H., Zhao, T., 2011. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig. Surg., 28(5–6):331–337. [doi:10.1159/000330782]PubMedCrossRefGoogle Scholar
  3. Corley, D.A., Buffler, P.A., 2001. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the cancer incidence in five continents database. Int. J. Epidemiol., 30(6):1415–1425. [doi:10.1093/ije/30.6.1415]PubMedCrossRefGoogle Scholar
  4. Crew, K.D., Neugut, A.I., 2004. Epidemiology of upper gastrointestinal malignancies. Semin. Oncol., 31(4):450–464. [doi:10.1053/j.seminoncol.2004.04.021]PubMedCrossRefGoogle Scholar
  5. Ding, J., Liao, G.Q., Liu, H.L., Liu, S., Tang, J., 2012. Meta-analysis of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer. J. Surg. Oncol., 105(3):297–303. [doi:10.1002/jso.22098]PubMedCrossRefGoogle Scholar
  6. Du, X.H., Li, R., Chen, L., Shen, D., Li, S.Y., Guo, Q., 2009. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer: initial experience. Chin. Med. J. (Engl.), 122(12):1404–1407.Google Scholar
  7. Edge, S.B., Compton, C.C., 2010. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann. Surg. Oncol., 17(6):1471–1474.PubMedCrossRefGoogle Scholar
  8. Frazee, R.C., Roberts, J.W., Okeson, G.C., Symmonds, R.E., Snyder, S.K., Hendricks, J.C., Smith, R.W., 1991. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Ann. Surg., 213(6): 651–653, 653–654.Google Scholar
  9. Goetze, T., Paolucci, V., 2006. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg. Endosc., 20(2):286–293. [doi:10.1007/s00464-005-0121-x]PubMedCrossRefGoogle Scholar
  10. Gutt, C.N., Riemer, V., Kim, Z.G., Erceg, J., Lorenz, M., 2001. Impact of laparoscopic surgery on experimental hepatic metastases. Br. J. Surg., 88(3):371–375. [doi:10.1046/j.1365-2168.2001.01700.x]PubMedCrossRefGoogle Scholar
  11. Hamabe, A., Omori, T., Tanaka, K., Nishida, T., 2012. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg. Endosc., 26(6):1702–1709. [doi:10.1007/s00464-011-2096-0]PubMedCrossRefGoogle Scholar
  12. Hayashi, H., Ochiai, T., Shimada, H., Gunji, Y., 2005. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg. Endosc., 19(9):1172–1176. [doi:10.1007/s00464-004-8207-4]PubMedCrossRefGoogle Scholar
  13. Hosono, S., Arimoto, Y., Ohtani, H., Kanamiya, Y., 2006. Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy. World J. Gastroenterol., 12(47):7676–7683.PubMedGoogle Scholar
  14. Huang, J.L., Wei, H.B., Zheng, Z.H., Wei, B., Chen, T.F., Huang, Y., Guo, W.P., Hu, B., 2010. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer. Dig. Surg., 27(4):291–296. [doi:10.1159/000281818]PubMedCrossRefGoogle Scholar
  15. Hur, H., Jeon, H.M., Kim, W., 2008. Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J. Surg. Oncol., 98(7):515–519. [doi:10.1002/jso.21155]PubMedCrossRefGoogle Scholar
  16. Huscher, C.G., Mingoli, A., Sgarzini, G., Sansonetti, A., Di Paola, M., Recher, A., Ponzano, C., 2005. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann. Surg., 241(2):232–237. [doi:10.1097/01.sla.0000151892.35922.f2]PubMedCrossRefGoogle Scholar
  17. Hwang, S.I., Kim, H.O., Yoo, C.H., Shin, J.H., Son, B.H., 2009. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg. Endosc., 23(6):1252–1258. [doi:10.1007/s00464-008-0140-5]PubMedCrossRefGoogle Scholar
  18. Kim, H.H., Hyung, W.J., Cho, G.S., Kim, M.C., Han, S.U., Kim, W., Ryu, S.W., Lee, H.J., Song, K.Y., 2010. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report— a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann. Surg., 251(3):417–420. [doi:10. 1097/SLA.0b013e3181cc8f6b]PubMedCrossRefGoogle Scholar
  19. Kim, S.H., Milsom, J.W., Gramlich, T.L., Toddy, S.M., Shore, G.I., Okuda, J., Fazio, V.W., 1998. Does laparoscopic vs. conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer? Dis. Colon. Rectum, 41(8):971–978. [doi:10.1007/BF02237382]PubMedCrossRefGoogle Scholar
  20. Kim, Y.W., Baik, Y.H., Yun, Y.H., Nam, B.H., Kim, D.H., Choi, I.J., Bae, J.M., 2008. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann. Surg., 248(5):721–727. [doi:10.1097/SLA.0b013e318185e62e]PubMedCrossRefGoogle Scholar
  21. Kim, Z.G., Mehl, C., Lorenz, M., Gutt, C.N., 2002. Impact of laparoscopic CO2-insufflation on tumor-associated molecules in cultured colorectal cancer cells. Surg. Endosc., 16(8):1182–1186. [doi:10.1007/s00464-001-9194-3]PubMedCrossRefGoogle Scholar
  22. Kitano, S., Iso, Y., Moriyama, M., Sugimachi, K., 1994. Laparoscopy-assisted Billroth I gastrectomy. Surg. Laparosc. Endosc., 4(2):146–148.PubMedGoogle Scholar
  23. Kitano, S., Shiraishi, N., Fujii, K., Yasuda, K., Inomata, M., Adachi, Y., 2002. A randomized controlled trial comparing open vs. laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery, 131(s1):S306–S311. [doi:10.1067/msy.2002.120115]PubMedCrossRefGoogle Scholar
  24. Lee, J.H., Han, H.S., Lee, J.H., 2005. A prospective randomized study comparing open vs. laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg. Endosc., 19(2):168–173. [doi:10.1007/s00464-004-8808-y]PubMedCrossRefGoogle Scholar
  25. Lee, Y.J., Ha, W.S., Park, S.T., Choi, S.K., Hong, S.C., 2007. Port-site recurrence after laparoscopy-assisted gastrectomy: report of the first case. J. Laparoendosc. Adv. Surg. Tech. A, 17(4):455–457. [doi:10.1089/lap.2006.0216]PubMedCrossRefGoogle Scholar
  26. Liang, Y., Li, G., Chen, P., Yu, J., Zhang, C., 2011. Laparoscopic versus open gastrectomy for early distal gastric cancer: a meta-analysis. ANZ J. Surg., 81(10):673–680. [doi:10.1111/j.1445-2197.2010.05599.x]PubMedCrossRefGoogle Scholar
  27. MacLehose, R.R., Reeves, B.C., Harvey, I.M., Sheldon, T.A., Russell, I.T., Black, A.M., 2000. A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies. Health Technol. Assess., 4(34): 1–154.PubMedGoogle Scholar
  28. McMahon, A.J., Baxter, J.N., Kenny, G., O’Dwyer, P.J., 1993. Ventilatory and blood gas changes during laparoscopic and open cholecystectomy. Br. J. Surg., 80(10):1252–1254. [doi:10.1002/bjs.1800801010]PubMedCrossRefGoogle Scholar
  29. Miura, S., Kodera, Y., Fujiwara, M., Ito, S., Mochizuki, Y., Yamamura, Y., Hibi, K., Ito, K., Akiyama, S., Nakao, A., 2004. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J. Am. Coll. Surg., 198(6):933–938. [doi:10.1016/j.jamcollsurg.2004.01.021]PubMedCrossRefGoogle Scholar
  30. Mochiki, E., Nakabayashi, T., Kamimura, H., Haga, N., Asao, T., Kuwano, H., 2002. Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J. Surg., 26(9):1145–1149. [doi:10.1007/s00268-002-6286-8]PubMedCrossRefGoogle Scholar
  31. Nakajima, T., 2002. Gastric cancer treatment guidelines in Japan. Gastric. Cancer, 5(1):1–5. [doi:10.1007/s101200200000]PubMedCrossRefGoogle Scholar
  32. Park Do, J., Han, S.U., Hyung, W.J., Kim, M.C., Kim, W., Ryu, S.Y., Ryu, S.W., Song, K.Y., Lee, H.J., Cho, G.S., et al., 2012. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg. Endosc., 26(6): 1548–1553. [doi:10.1007/s00464-011-2065-7]CrossRefGoogle Scholar
  33. Parkin, D.M., Muir, C.S., 1992. Cancer incidence in five continents. Comparability and quality of data. IARC Sci. Publ., (120):45–173.Google Scholar
  34. Petitti, D.B., 1994. Of babies and bathwater. Am. J. Epidemiol., 140(9):779–782.PubMedGoogle Scholar
  35. Powell, J., McConkey, C.C., Gillison, E.W., Spychal, R.T., 2002. Continuing rising trend in oesophageal adenocarcinoma. Int. J. Cancer, 102(4):422–427. [doi:10.1002/ijc.10721]PubMedCrossRefGoogle Scholar
  36. Reza, M.M., Blasco, J.A., Andradas, E., Cantero, R., Mayol, J., 2006. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br. J. Surg., 93(8): 921–928. [doi:10.1002/bjs.5430]PubMedCrossRefGoogle Scholar
  37. Shapiro, S., 1994. Meta-analysis/Shmeta-analysis. Am. J. Epidemiol., 140(9):771–778.PubMedGoogle Scholar
  38. Shuang, J., Qi, S., Zheng, J., Zhao, Q., Li, J., Kang, Z., Hua, J., Du, J., 2011. A case-control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J. Gastrointest. Surg., 15(1):57–62. [doi:10.1007/s11605-010-1361-1]PubMedCrossRefGoogle Scholar
  39. Songun, I., Putter, H., Kranenbarg, E.M., Sasako, M., van de Velde, C.J., 2010. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol., 11(5):439–449. [doi:10. 1016/S1470-2045(10)70070-X]PubMedCrossRefGoogle Scholar
  40. Strong, V.E., Devaud, N., Allen, P.J., Gonen, M., Brennan, M.F., Coit, D., 2009. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case-control study. Ann. Surg. Oncol., 16(6):1507–1513. [doi:10.1245/s10434-009-0386-8]PubMedCrossRefGoogle Scholar
  41. Strong, V.E., Song, K.Y., Park, C.H., Jacks, L.M., Gonen, M., Shah, M., Coit, D.G., Brennan, M.F., 2010. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann. Surg., 251(4):640–646. [doi:10.1097/SLA.0b013e3181d3d29b]PubMedCrossRefGoogle Scholar
  42. Tokunaga, M., Hiki, N., Fukunaga, T., Miki, A., Nunobe, S., Ohyama, S., Seto, Y., Yamaguchi, T., 2009. Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center. Surg. Endosc., 23(2): 289–295. [doi:10.1007/s00464-008-9902-3]PubMedCrossRefGoogle Scholar
  43. Vinuela, E.F., Gonen, M., Brennan, M.F., Coit, D.G., Strong, V.E., 2012. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann. Surg., 255(3):446–456. [doi:10.1097/SLA.0b013e 31824682f4]PubMedCrossRefGoogle Scholar

Copyright information

© Zhejiang University and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Long-yun Ye
    • 1
  • Da-ren Liu
    • 1
  • Chao Li
    • 1
  • Xiao-wen Li
    • 1
  • Ling-na Huang
    • 1
  • Sheng Ye
    • 1
  • Yi-xiong Zheng
    • 1
  • Li Chen
    • 1
  1. 1.Department of Surgery, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina

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