Systematic Review Of Laparoscopy-assisted Distal Gastrectomy For The Treatment Of Early Gastric Cancer

Objective:The aim of the systematic review is to compare the safety and efficacy of laparoscope-assisted distal gastrectomy for the treatment of early gastric cancer with open distal gastrectomy.Methods:We searched articles published in MEDLINE(1991-2006),EMBASE (1991-2006),Chinese Biomedical literature Database(CBM)(1991-2006),CMKI (1994-2006),VIP(1991-2006)and The Cochrane Library(No.4,2006).Randomized controlled Trials(RCTs)or Quasi-randomized controlled trials(CCTs)comparing LADG with ODG were included.Wealso evaluated the quality of included studies that involved randomization,blinding,allocation concealment.Weighted mean difference(WMD) between continuous variables was calculated.For dichotomous data,relative risk(RR)or odds radio(OR)was determined.All effect values were expressed by 95%confidence intervals(CI).Meta-analysis was performed using Revman4.2.9 software.Results:Four RCTs involving 123 patients were included.Compared with ODG, LADG was associated with less complications[odds ratio(OR)0.33 95%confidence interval(CI)(0.14 to 0.77)],this was most significant for pulmonary complications [WMD 0.28 95%CI(0.08 to 0.96)].Estimated blood loss[weight mean difference (WMD)-85.72 95%CI(-166.87 to -4.58)]was less,the frequency[WMD -1.69 95%CI (-2.18 to -1.21)]and duration[WMD -1.68 95%CI(-2.11 to -1.25)]of analgesics required were lower,time to postoperative first flatus[WMD -0.68 95%CI(-1.26 to -0.09)]was faster after LANG.Surgery press was less in LADG than in ODG,and the Th1/Th2 balance was preserved after LADG.There was no significant difference between two groups in duration of hospital stay[WMD -3.18 95%CI(-9.08 to 2.72)], delayed gastric emptying[OR 0.71 95%CI(0.14 to 3.63)],wound and anastomosis complications and time to start first oral intake[WMD -0.97 95%CI(-2.47 to 0.54)]. There was also no statistical difference in disease recurrence rate,metastasis rate,death rate and survival rate.At the same time,the result showed that the operation time was significantly longer in LADG.The mean number of harvested lymph nodes was less or equal to ODG.Conclusion:Laparoscope-assisted radical subtotal gastrectomy for distal gastric cancer is a safe and feasible oncologic procedure with better short-term results and similar long-term results compared with ODG.Additional benefits for the LADG were reduced slighter pain,less estimated blood loss,less postoperative complications,rapid recovery of gastrointestinal function and less effect of immune function.