Summary:
AIM: Review of the literature collecting trials comparing laparoscopic (LGD2)
and open D2 gastrectomies (OGD2) for the treatment of advanced gastric cancer
(AGC).
METHODS: Randomized control trials (RCTs) and non-RCTs comparing LGD2 with OGD2
for AGC treatment, published between 1 January 2000 to 31 December 2014 were
identified by searching the Pubmed, EMBASE and Cochrane Library databases.
Primary endpoints included operative outcomes (operative time, intraoperative
blood loss, number of transfused patients and conversion rates), postoperative
outcomes (postoperative analgesic consumption, time to first ambulation, time
to first flatus, time to first oral intake, duration of body temperature >37
oC, length of postoperative hospital stay, postoperative morbidity, incidence
of reoperation and postoperative in-hospital mortality), and oncologic outcomes
(number of harvested lymph nodes, tumor recurrence, disease-free rates and
overall survival rates). The modified Newcastle-Ottawa scale was used to assess
the quality of RCTs and non-RCTs in the study.
RESULTS: One RCT and 10 non-RCTs with a total of 1693 patients were included in
the review. LGD2 when compared to OGD2 demonstrated significant lower
intraoperative blood loss [8 out of 9 studies; mean difference (MD) = 124,65
ml], shorter duration of analgesic administration (4 out of 4 studies; MD = 1,9
days), shorter times to first ambulation (2 out 7 studies; MD = 1,65 days),
flatus (7 out of 9 studies; MD = 1,1 days), and oral intake (5 out of 7
studies; MD = 0,98 days), shorter length of body temperature > 37 oC (3 out of
3 studies; MD = 2,2 days), shorter postoperative hospital stay (7 out 10
studies; MD = 3,67 days), lower incidence of nonsurgical complications (3 out
of 3 studies). No significant differences were observed between LGD2 and OGD2
for the following criteria: postoperative in-hospital mortality, number of
harvested lymph nodes, tumor recurrence, 5-year disease-free survival rates and
five- or three-year overall survival rates. However, LGD2 had longer operative
times (7 out of 11 studies; MD = 67,66 min).
CONCLUSION: Although a technically demanding and time-consuming procedure, LGD2
offers the advantages of minimal invasion and can achieve the same degree of
radicality, harvested lymph nodes and short- or long-term prognosis for the
treatment of locally AGC.