Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 900-911
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.900
Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis
Song Wang, Mei-Lan Su, Yang Liu, Zhi-Ping Huang, Ning Guo, Tian-Jin Chen, Zhong-Hui Zou
Song Wang, Yang Liu, Zhi-Ping Huang, Ning Guo, Tian-Jin Chen, Zhong-Hui Zou, Department of Stomach/Thyroid/Vascular Surgery, Chongqing Three Gorges Central Hospital, Chongqing 404000, China
Mei-Lan Su, Department of Psychosomatic Medicine, Chongqing Three Gorges Central Hospital, Chongqing 404000, China
Author contributions: Wang S and Su ML contributed to the study design, data collection, and paper writing; Zou ZH contributed to the study design, and critical revision of the paper; Liu Y, Huang ZP, Guo N, and Chen TJ contributed to the data collection. All authors have approved the final version to be published.
Supported by the Ethics Committee of Chongqing Three Gorges Central Hospital, and the Guiding Project of Science and Technology Plan for Social Development in Wanzhou District Chongqing, No. wzstc-z 201707.
Conflict-of-interest statement: The authors deny any 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhong-Hui Zou, MA, Surgeon, Department of Stomach/Thyroid/Vascular Surgery, Chongqing Three Gorges Central Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing 404000, China. zouzhonghui97@163.com
Received: December 6, 2019
Peer-review started: December 6, 2019
First decision: December 30, 2019
Revised: February 18, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 6, 2020
ARTICLE HIGHLIGHTS
Research background

Laparoscopic total gastrectomy for gastric cancer includes laparoscopic-assisted total gastrectomy (LATG) and totally laparoscopic total gastrectomy (TLTG). The main difference between LATG and TLTG is the route of digestive tract reconstruction. Needless to say, TLTG has the advantage of being more minimally invasive when compared with LATG. However, TLTG has not yet been promoted, mainly because the safety and feasibility of intracorporeal esophagojejunostomy of TLTG have not been determined.

Research motivation

If the safety and feasibility of intracorporeal esophagojejunostomy of TLTG for gastric cancer can be confirmed, TLTG may be more widely used in clinical practice due to its unique advantages.

Research objectives

The present meta-analysis was performed to compare the short-term efficacy of TLTG and LATG for gastric cancer, and investigate the safety and feasibility of totally laparoscopic esophagojejunostomy in order to obtain the best evidence to guide clinical practice.

Research methods

We collected high-quality published articles on TLTG vs LATG for gastric cancer via English language databases (such as PubMed, EMBASE, and Web of Science). All the basic conditions of patients (e.g. the first author, nationality, publication time, sample size, age, body mass index) and important clinical data related to surgery (e.g. the operating time, anastomotic time, intraoperative blood loss, tumor size, proximal resection margin length, number of retrieved lymph nodes, postoperative pain score, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative anastomosis-related complication rate and overall complication rate) were extracted. A comprehensive and detailed comparison of two surgical approaches (TLTG vs LATG) for gastric cancer was performed by meta-analysis to explore the efficacy differences.

Research results

Compared with the LATG group, reduced intraoperative blood loss and a larger number of retrieved lymph nodes were found in the TLTG group. There were no significant differences in operating time, anastomotic time, tumor size, proximal resection margin length, postoperative pain score, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative anastomosis-related complication rate and overall complication rate between the two groups.

Research conclusions

We confirmed the clinical safety and feasibility of TLTG for gastric cancer, and TLTG has the advantages of being minimally invasive, reduced intraoperative blood loss and easier access to lymph nodes compared to LATG.

Research perspectives

We speculate that totally laparoscopic radical gastrectomy for gastric cancer is likely to be the surgical trend for gastric cancer in the future.