Laparoscopic Versus Conventional Open Resection For Early Distal Gastric Cancer: A Meta-analysis On Short-term Outcomes

Objective To compare the short-term outcomes between laparoscopic and conventional open resection for early distal gastric cancer with Meta-analysis.Methods Original articles published from January 2000 to December 2008 were searched. According to the inclusion criterion, 16 articles were enrolled which compared the short-term outcomes between laparoscopic and conventional open resection for early distal gastric cancer. Data were extracted from these trials by 3 reviewers independently and analyzed by Rev Man 5.0 software.Results 1583 patients with early distal gastric cancer were enrolled. In the combined results, although it was a longer procedure(weighted mean difference [WMD] 46.88, 95% confidence interval [CI] 34.29 to 59.47,P<0.00001, laparoscopic resection was associated with less blood loss( WMD-122.71,95%CI -171.67 to -73.76,P<0.00001),less frequency of additional analgesic requirement (WMD-1.22,95%CI -2.17 to -0.26,P=0.01 ) ,less time to flatus ( WMD-0.64 , 95%CI -0.90 to -0.39,P<0.00001),less time to oral intake(WMD-0.93,95%CI -1.29 to -0.58,P<0.00001), shorter duration of hospital stay(WMD-5.17,95%CI -7.43 to -2.19,P<0.00001).Also, the complication rate was significantly lower with laparoscopic resection (odds ratio [OR] 0.46, 95% CI 0.32 to 0.64,P < 0.00001). When we analyzed the number of the lymph nodes, a mean of 3.26 less number of dissected lymph nodes than conventional open resection (WMD -3.26, 95%CI-6.24～-0.27,P=0.03) when all studies were included. However, there was no significant difference between laparoscopic surgery and conventional open surgery in the subgroups of articles published during 2005-2008 years (WMD -2.84, 95%CI -6.79～1.11,P=0.16), D+α/βlymph node dissection (WMD-2.80,95%CI -7.57～1.97,P=0.25) and retrospective non-randomized trial (WMD-2.89, 95%CI-6.48～0.70,P=0.11).Conclusion Compared to conventional open resection, laparoscopic resection is a safe and feasible technical for early distal gastric cancer with less trauma ,faster postoperative recovery and lower overall complication rate,although it's operation time is longer.And With the improvement of surgeons'skill ,laparoscopic surgery and open surgery do not differ significantly in the number of retrieved lymph nodes for early distal gastric cancer with D1+α/βlymph node dissection.