Laparoscopic vs open total gastrectomy for gastric cancer: A meta-analysis

doi:10.3748/wjg.v19.i44.8114

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World Journal of Gastroenterology

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Meta-Analysis

World J Gastroenterol. Nov 28, 2013; 19(44): 8114-8132
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8114

Table 1 Study characteristics

Author, year	Country	Study design	Group	No. of patients	Age(yr)	Gender(M/F)	BMI(kg/m²)	ASA (1:2:3)	Tumorsize (cm)	Tumor stage¹	Extent of LND	Population
Dulucq et al[28], 2005	France	PCS	LTG	8	75 ± 8	3/5	NA	NA	5.5 ± 2	NA	D1 + β	EGC + AGC
Dulucq et al[28], 2005			OTG	11	67 ± 14	5/6	NA	NA	6.1 ± 0.4	NA
Usui et al[9], 2005	Japan	RCS	LTG	20	66.0 ± 10.4	13/7	21.3 ± 3.1	NA	NA	8/10/2/0/0	D1 + β	EGC + AGC
Usui et al[9], 2005			OTG	19	66.2 ± 10.2	14/5	22.1 ± 2.4	NA	NA	10/8/1/0/0
Kim et al[34], 2008	South Korea	RCS	LTG	27	57.3 ± 14.2	16/11	22.6 ± 3.1	NA	NA	NA	D1 + α/β, D2	EGC + AGC
Kim et al[34], 2008	South Korea		OTG	33	61.6 ± 9.2	23/10	22.4 ± 2.1	NA	NA	NA
Mochiki et al[15], 2008	Japan	RCS	LTG	20	66 ± 2.4	16/4	NA	NA	3.6 ± 0.5	NA	D1 + β	EGC
Mochiki et al[15], 2008			OTG	18	63 ± 2.2	16/2	NA	NA	5.7 ± 0.8	NA
Topal et al[14], 2008	Belgium	PCS	LTG	38	68 (37-85)	23/15	24 (17-30)	NA	47 (7-180)	0/17/7/10/4	D2	EGC + AGC
Topal et al[14], 2008			OTG	22	69 (38-86)	17/5	24 (17-30)	NA	30 (10-180)	0/7/7/6/2
Kawamura et al[30], 2009	Japan	RCS	LTG	46	64 ± 10.4	10/36	22.8 ± 3.0	15/27/4	NA	NA	D2	EGC
Kawamura et al[30], 2009			OTG	35	65.2 ± 10.7	10/25	22.9 ± 2.4	14/15/6	NA	NA
Sakuramoto et al[16], 2009	Japan	RCS	LTG	30	63.7 ± 9.2	12/18	21.9 ± 2.7	9/20/1	4.0 ± 2.9	0/25/2/3/0	D1 + β, D2	EGC + AGC
Sakuramoto et al[16], 2009			OTG	44	67.2 ± 9.9	10/34	22.5 ± 3.6	8/28/8	6.1 ± 3.7	0/15/17/12/0
Du et al[27], 2010	China	RCS	LTG	82	60.4 ± 18.5	54/28	22.3 ± 2.6	NA	5.4 ± 1.4	0/3/36/43/0	D2	AGC
Du et al[27], 2010			OTG	94	57.8 ± 17.2	61/33	22.5 ± 2.4	NA	5.9 ± 1.6	0/6/31/57/0
Kim et al[33], 2011	South Korea	RCS	LTG	63	55.9 ± 12.2	43/20	22.7 ± 2.5	45/15/3	3.8 ± 2.1	NA	D2	EGC
Kim et al[33], 2011	South Korea		OTG	127	57.3 ± 11.1	81/46	23.0 ± 2.9	86/39/2	3.9 ± 2.7	NA
Eom et al[10], 2012	South Korea	RCS	LTG	100	54.9 ± 13.5	57/43	22.7 ± 2.8	NA	4.3 ± 2.9	NA	D1 + β, D2	EGC + AGC
Eom et al[10], 2012	South Korea		OTG	348	58.7 ± 11.5	254/94	23.8 ± 2.9	NA	4.4 ± 3.0	NA
Guan et al[17], 2012	China	RCS	LTG	41	60.7 ± 9.1	33/8	NA	NA	NA	0/18/20/3/0	D2	EGC + AGC
Guan et al[17], 2012			OTG	56	57.8 ± 9.9	40/16	NA	NA	NA	0/25/25/6/0
Siani et al[38], 2012	Italy	RCS	LTG	25	65 ± 8.5	15/10	NA	NA	NA	0/6/5/14/0	D1 + α/β, D2	EGC + AGC
Siani et al[38], 2012			OTG	25	66 ± 7.8	18/7	NA	NA	NA	0/4/5/16/0
Kim et al[32], 2013	South Korea	RCS	LTG	139	58 (30-84)	86/53	23.6 (13.6-32.4)	85/46/8	3.2 (0.2, 15)	NA	D2	EGC + AGC
Kim et al[32], 2013	South Korea		OTG	207	56 (31-84)	134/73	24.1 (16.7-35.2)	137/52/18	4.0 (0.3, 22)	NA
Jeong et al[29], 2013	South Korea	RCS	LTG	122	63.2 ± 11.2	89/33	23.1 ± 3.4	33/80/9	NA	NA	D1 + β, D2	EGC + AGC
Jeong et al[29], 2013	South Korea		OTG	122	62.6 ± 11.7	93/29	23.5 ± 3.2	43/67/12	NA	NA
Lee et al[37], 2013	South Korea	RCS	LTG	50	50.6 ± 22.1	32/18	23.2 ± 3.7	34/11/5	NA	0/24/13/9/4	D2	EGC + AGC
Lee et al[37], 2013	South Korea		OTG	50	51 ± 22.6	32/18	23 ± 3.4	31/16/3	NA	0/24/13/9/4

Continuous variables are presented as means ± SD or median and range.

¹Pathological tumor stage (0/I/II/III/IV). PCS: Prospective comparative study; RCS: Retrospective comparative study; LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; BMI: Body mass index; NA: Not available; ASA: American Society of Anesthesiologists; LND: Lymph node dissection; EGC: Early gastric cancer; AGC: Advanced gastric cancer; M/F: Male/female.

Table 2 Quality assessment scoring of included studies, according to NOS criterion

Author, year	Selection			Comparability¹		Outcome assessment		Star Score
	1	2	3	4	5	6	7
Dulucq et al[28], 2005	*	*	*	*		*	*	******
Usui et al[9], 2005	*	*	*			*	*	*****
Kim et al[34], 2008	*	*	*			*		****
Mochiki et al[15], 2008	*	*	*	*		*	*	******
Topal et al[14], 2008	*	*	*	**	**	*		********
Kawamura et al[30], 2009	*	*	*	**	*	*	*	********
Sakuramoto et al[16], 2009	*	*	*	**		*	*	*******
Du et al[27], 2010	*	*	*	**		*	*	*******
Kim et al[33], 2011	*	*	*	**	*	*		*******
Eom et al[10], 2012	*	*	*			*	*	*****
Guan et al[17], 2012	*	*	*		*	*		*****
Siani et al[38], 2012	*	*	*	*	*	*	*	*******
Kim et al[32], 2013	*	*	*	**		*		******
Jeong et al[29], 2013	*	*	*	**	*	*		*******
Lee et al[37], 2013	*	*	*	**	*	*	*	********

Based on Newcastle-Ottowa Scale with maximum of *** for selection, ****for comparability, and ** for outcome assessment.

¹Comparability variables are (1) age, (2) sex, (3) body mass index, (4) American Society of Anesthesiologists, (5) comorbidity, (6) tumor size and (7) tumor stage. Group comparable for (1)-(3) or (4)-(7) (if yes, two stars, one star if one of these three characteristics was not reported, even if there were no other differences between the two groups and other characteristics had been controlled; no points were assigned if the two groups differed).

Table 3 Perioperative outcomes

Author, year	Group	Operation time (min)	Intraoperative blood loss (mL)	No. of resected lymph nodes(n)	Time to first ﬂatus (d)	Time to first oral intake(d)	Hospital stay(d)	Analgesics use (times)	Postoperative complications (%)	In-hospitalMortality (%)
Dulucq et al[28], 2005	LTG	183 ± 48	81 ± 107	24 ± 12	3.6 ± 1.2	NA	16.9 ± 3	NA	0	0
Dulucq et al[28], 2005	OTG	165 ± 60	125 ± 95	20 ± 8	4.7 ± 1.2	NA	24 ± 9	NA	18	9
Usui et al[9], 2005	LTG	280.1 ± 45.2	227.5 ± 148.1	28.0 ± 15.1	2.9 ± 0.9	5.7 ± 2.1	15.5 ± 3.9	2.1 ± 1.3	NA	NA
Usui et al[9], 2005	OTG	266.4 ± 48.2	393.1 ± 173.6	28.9 ± 14.3	4.2 ± 1.4	8.8 ± 1.3	23.2 ± 4.6	3.4 ± 4.4	NA	NA
Kim et al[34], 2008	LTG	527.5 ± 95.7	NA	27.2 ± 15.7	3.6 ± 0.9	NA	16.2 ± 7.1	NA	7.4	0
Kim et al[34], 2008	OTG	320.9 ± 75.8	NA	37.2 ± 15.7	4.1 ± 1.3	NA	16.0 ± 9.3	NA	24.2	0
Mochiki et al[15], 2008	LTG	254 ± 10	299 ± 50	26 ± 3	NA	NA	19 ± 3	NA	25	0
Mochiki et al[15], 2008	OTG	248 ± 12	758 ± 78	35 ± 4	NA	NA	29 ± 3	NA	16.7	0
Topal et al[14], 2008	LTG	187 ± 60	10.0 ± 98.8	NA	NA	NA	NA	NA	39.5	2.6
Topal et al[14], 2008	OTG	152.5 ± 25	450.0 ± 337.5	NA	NA	NA	NA	NA	40.9	4.5
Kawamura et al[30], 2009	LTG	291.9 ± 59.4	54.9 ± 45.3	48.5 ± 16.3	4.1 ± 1.0	NA	15.5 ± 3.3	6.9 ± 5.6	8.7	0
Kawamura et al[30], 2009	OTG	272.1 ± 76.8	304.3 ± 237.3	47.1 ± 21.5	4.3 ± 1.3	NA	18.8 ± 6.3	4.0 ± 3.2	22.9	0
Sakuramoto et al[16], 2009	LTG	313 ± 81	134 ± 98	43.2 ± 17.2	2.4 ± 1.1	4.9 ± 1.1	13.5 ± 2.7	6.8 ± 6.4	16.7	0
Sakuramoto et al[16], 2009	OTG	218 ± 53	407 ± 270	51.2 ± 22.1	3.3 ± 1.0	6.0 ± 2.1	18.2 ± 9.6	11.8 ± 11.0	27.3	0
Du et al[27], 2010	LTG	275 ± 78	156 ± 112	34.2 ± 13.5	3.5 ± 0.8	3.5 ± 0.8	NA	NA	9.8	0
Du et al[27], 2010	OTG	212 ± 51	339 ± 162	36.4 ± 19.1	5.3 ± 1.3	5.3 ± 1.3	NA	NA	24.5	2.1
Kim et al[33], 2011	LTG	150.8 ± 31.2	179.7 ± 123.8	38.7 ± 15.7	3.3 ± 0.7	4.3 ± 1.7	8.1 ± 3.8	5.3 ± 4.9	12.7	0
Kim et al[33], 2011	OTG	131.2 ± 21.6	272.7 ± 209.6	35.6 ± 13.1	3.8 ± 0.8	5.6 ± 4.4	9.6 ± 5.3	3.6 ± 3.9	18.9	0
Eom et al[10], 2012	LTG	283.7 ± 84.1	NA	48.3 ± 16.4	NA	NA	12.6 ± 15.5	NA	27	1
Eom et al[10], 2012	OTG	198.5 ± 59.7	NA	49.8 ± 18.4	NA	NA	14.3 ± 16.7	NA	23.6	0.9
Guan et al[17], 2012	LTG	235.7 ± 38.5	104.2 ± 42.9	23.1 ± 8.0	3 ± 0.7	2.2 ± 0.9	9.7 ± 2.2	NA	4.9	0
Guan et al[17], 2012	OTG	211.5 ± 33.2	355.6 ± 51.3	24.2 ± 7.5	3.3 ± 0.4	3.1 ± 0.5	13.6 ± 3.6	NA	5.4	0
Siani et al[38], 2012	LTG	211 ± 23	250 ± 150	35 ± 18	2.1 ± 0.9	NA	10.5 ± 1.5	NA	16	0
Siani et al[38], 2012	OTG	185 ± 19	495 ± 190	40 ± 16	4.1 ± 1.5	NA	14.5 ± 3.1	NA	4	0
Kim et al[32], 2013	LTG	144 ± 104.3	NA	37 ± 24	3 ± 2	3 ± 12.3	7 ± 19.3	3 ± 24.5	10	0
Kim et al[32], 2013	OTG	137 ± 105	NA	34 ± 18.8	4 ± 2.3	5 ± 10	8 ± 9	4 ± 9.3	21.7	0
Jeong et al[29], 2013	LTG	289 ± 89	249 ± 204	42 ± 15	2.9 ± 0.8	3.9 ± 4.4	11.8 ± 11.8	NA	23.8	1.6
Jeong et al[29], 2013	OTG	203 ± 78	209 ± 157	46 ± 17	3.0 ± 0.8	3.6 ± 3.3	10.8 ± 7.0	NA	17.2	0.9
Lee et al[37], 2013	LTG	258 ± 54	167.3 ± 135.2	48.4 ± 18.4	4 ± 1.2	5 ± 1.7	9.3 ± 4.2	NA	24	0
Lee et al[37], 2013	OTG	198 ± 57	178.4 ± 107	54.3 ± 20.5	4.5 ± 1.5	6.1 ± 2.5	11.7 ± 7.3	NA	32	0

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; NA: Not available.

Table 4 Results of meta-analysis comparing laparoscopic total gastrectomy vs open total gastrectomy

Outcome of interest	No. of studies	No. of patients	OR/WMD	95%CI	P value	Heterogeneity P value	I²
Operative outcomes
Operation time (min)	15	2022	48.25	31.15-65.35	< 0.00001	< 0.00001	93%
Intraoperative blood loss (mL)	12	1168	-201.19	-296.50--105.87	< 0.0001	< 0.00001	98%
Postoperative recovery
Time to first ﬂatus (d)	12	1412	-0.82	-1.18--0.45	< 0.0001	< 0.00001	90%
Time to first oral intake (d)	8	1266	-1.3	-1.84--0.75	< 0.00001	< 0.00001	82%
Hospital stay (d)	13	1786	-3.55	-5.13--1.96	< 0.0001	< 0.00001	86%
Analgesics use (times)	5	730	-0.09	-2.39-2.20	0.94	0.0008	79%
Postoperative complications
Overall complication	14	1983	0.73	0.57-0.92	0.009	0.08	37%
Anastomotic leakage	14	1983	1.6	0.88-2.91	0.12	0.68	0%
Anastomotic stenosis	13	1923	1.22	0.68-2.21	0.50	0.95	0%
Ileus	13	1923	1.26	0.69-2.30	0.46	0.85	0%
Bleeding	13	1923	1.42	0.70-2.87	0.33	0.26	23%
Abdominal abscess	13	1923	0.53	0.28-1.03	0.06	0.37	8%
Wound problems	13	1923	0.39	0.21-0.72	0.002	0.75	0%
Oncological outcomes
Positive resection margins	5	698	0.57	0.03-9.55	0.69	-	-
No. of resected lymph nodes	14	1962	-2.49	-5.18-0.21	0.07	< 0.00001	74%
Proximal resection margin (cm)	4	1160	-0.26	-0.54-0.01	0.06	0.65	0%
Distal resection margin (cm)	4	1160	0.32	-0.05-0.68	0.09	0.22	32%

Citation: Xiong JJ, Nunes QM, Huang W, Tan CL, Ke NW, Xie SM, Ran X, Zhang H, Chen YH, Liu XB. Laparoscopic vs open total gastrectomy for gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19(44): 8114-8132
URL: https://www.wjgnet.com/1007-9327/full/v19/i44/8114.htm
DOI: https://dx.doi.org/10.3748/wjg.v19.i44.8114