Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1871-1882
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1871
Comparison efficacy and safety of total laparoscopic gastrectomy and laparoscopically assisted total gastrectomy in treatment of gastric cancer
Long Li, Dong-Yuan Liu, Jing Leng, Xue-Mei Tao, Hui-Qin Wu, Yan-Peng Zhu
Long Li, Dong-Yuan Liu, Yan-Peng Zhu, Department of General Surgery, The 971st Hospital of Chinese People's Liberation Army, Qingdao 266071, Shandong Province, China
Jing Leng, Department of Surgery, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
Xue-Mei Tao, Hyperbaric Oxygen Department, The Eighth Peoples Hospital of Qingdao, Qingdao 266121, Shandong Province, China
Hui-Qin Wu, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
Co-first authors: Long Li and Dong-Yuan Liu.
Author contributions: Li L and Liu DY wrote the manuscript; Tao XM collected the data; Wu HQ submitted the manuscript to the journal; Zhu YP guided the study; all authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work. Li L and Liu DY contributed equally to this work as co-first authors. The reasons for designating Li L and Liu DY as co-first authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-first authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability; Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-first authors best reflect this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives; Third, Li L and Liu DY contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Li L and Liu DY as co-first authors is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Conflict-of-interest statement: All the authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Peng Zhu, MM, Doctor, Department of General Surgery, The 971st Hospital of Chinese People's Liberation Army, No. 22 Minjiang Road, Shinan District, Qingdao 266071, Shandong Province, China. ptwk1122@163.com
Received: February 4, 2024
Revised: April 19, 2024
Accepted: April 29, 2024
Published online: June 27, 2024
Processing time: 146 Days and 13.4 Hours
Abstract
BACKGROUND

The development of laparoscopic technology has provided a new choice for surgery of gastric cancer (GC), but the advantages and disadvantages of laparoscopic total gastrectomy (LTG) and laparoscopic-assisted total gastrectomy (LATG) in treatment effect and safety are still controversial. The purpose of this study is to compare the efficacy and safety of the two methods in the treatment of GC, and to provide a basis for clinical decision-making.

AIM

To compare the efficacy of totally LTG (TLTG) and LATG in the context of radical gastrectomy for GC. Additionally, we investigated the safety and feasibility of the total laparoscopic esophagojejunostomy technique.

METHODS

Literature on comparative studies of the above two surgical methods for GC (TLTG group and LATG group) published before September 2022 were searched in the PubMed, Web of Science, Wanfang Database, CNKI, and other Chinese and English databases. In addition, the following search keywords were used: Gastric cancer, total gastrectomy, total laparoscopy, laparoscopy-assisted, esophagojejunal anastomosis, gastric/stomach cancer, total gastrectomy, totally/completely laparoscopic, laparoscopic assisted/laparoscopy assisted/laparoscopically assisted, and esophagojejunostomy/esophagojejunal anastomosis. Review Manager 5.3 software was used for the meta-analysis after two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies.

RESULTS

After layer-by-layer screening, 258 pieces of literature were recovered, and 11 of those pieces were eventually included. This resulted in a sample size of 2421 instances, with 1115 cases falling into the TLTG group and 1306 cases into the LATG group. Age or sex differences between the two groups were not statistically significant, according to the meta-analysis, however the average body mass index of the TLTG group was considerably higher than that of the LATG group (P = 0.01). Compared with those in the LATG group, the incision length in the TLTG group was significantly shorter (P < 0.001), the amount of intraoperative blood loss was significantly lower (P = 0.003), the number of lymph nodes removed was significantly greater (P = 0.04), and the time of first postoperative feeding and postoperative hospitalization were also significantly shorter (P = 0.03 and 0.02, respectively). There were no significant differences in tumor size, length of proximal incisal margin, total operation time, anastomotic time, postoperative pain score, postoperative anal exhaust time, postoperative anastomosis-related complications (including anastomotic fistula, anastomotic stenosis, and anastomotic hemorrhage), or overall postoperative complication rate (P > 0.05).

CONCLUSION

TLTG and esophagojejunostomy are safe and feasible. Compared with LATG, TLTG has the advantages of less trauma, less bleeding, easier access to lymph nodes, and faster postoperative recovery, and TLTG is also suitable for obese patients.

Keywords: Total laparoscopic gastrectomy; Laparoscopically assisted total gastrectomy; Gastric cancer; Meta-analysis

Core Tip: This study used a systematic review and meta-analysis to determine how well and safely laparoscopic total gastrectomy and laparoscopically assisted total gastrectomy can treat gastric cancer (GC). Clinical trial data from relevant literature were collected and analyzed to evaluate the differences between the two surgical methods in terms of surgical effect, postoperative complications, and postoperative quality of life. Through the systematic synthesis of the results, an objective evaluation of the advantages and disadvantages of these two surgical methods is provided, which provides a scientific basis for clinicians to optimize the treatment of GC patients.