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Laparoscopic‐assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta‐analysis, and trial sequential analysis of randomized controlled trials
Author(s) -
Li HuiZi,
Chen JiaXi,
Zheng Yang,
Zhu XiangNan
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24243
Subject(s) - medicine , meta analysis , randomized controlled trial , gastrectomy , cancer , confidence interval , cochrane library , surgery , relative risk , quality of life (healthcare) , nursing
Background Previous studies comparing laparoscopic‐assisted to open gastrectomy (OG) for resectable gastric cancer were inexhaustive, so an updated meta‐analysis was performed to clarify quality of life, patient satisfaction, safety and effectiveness associated with laparoscopic‐assisted gastrectomy (LAG). Methods Pubmed, Embase, and The Cochrane Library were searched from inception to December 2015 for randomized controlled trials (RCTs) comparing LAG with OG for resectable gastric cancer. Relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were pooled with random‐effects model. Furthermore, trial sequential analysis (TSA) was employed to indicate the credibility of pooled estimate. Results Fourteen RCTs totaling 2,307 gastric cancer patients (1,163 in laparoscopic and 1,144 in open) were included. Compared with OG, LAG showed higher patient satisfaction and quality of life, less blood loss, hospital stay and overall postoperative morbidity, and longer operating time, which were confirmed by TSA. LAG also accelerated time to first flatus, first walking and first intake and reduced frequency of analgesic administration and days of fever. There were no significant difference between the two groups in number of retrieved lymph nodes, mortality, recurrence, long‐term overall survival and disease‐free survival. Conclusion For patients with resectable gastric cancer, LAG decreased blood loss, length of hospital stay and overall postoperative morbidity and improved postsurgical recovery. J. Surg. Oncol. 2016;113:756–767 . © 2016 Wiley Periodicals, Inc.