A Meta-analysis That Compared Laparoscopy-Assisted And Open Distal Gastrectomy For Early Gastric Cancer

Background: We conducted a meta-analysis to evaluate and compare theadvantages of laparoscopy-assisted distal gastrectomy (LADG) over opendistal gastrectomy (ODG) for treating early gastric cancer (EGC). Methods:We searched MEDLINE, EMBASE, Science Citation Index, and CochraneControlled Trial Register for relevant papers published between January1990and January2010by using the following search terms: laparoscopy-assistedgastrectomy, laparoscopic gastrectomy, and early gastric cancer. Thefollowing data were analyzed: operative time, estimated blood loss, number ofharvested lymph nodes, time required for resumption of oral intake, durationof hospital stay, frequency of analgesic administration, complications, tumorrecurrence, and mortality. Results: We selected four papers reportingrandomized control studies (RCTs) that compared LADG with ODG for EGC.Our meta-analysis included267patients with EGC; of these,134and133hadundergone LADG and ODG, respectively. The volume of intra operative bloodloss, frequency of analgesic administration, and rate of complications weresignificantly lesser for LADG than for ODG. However, the time required forresumption of oral intake and duration of hospital stay did not significantlydiffer between LADG and ODG. The operative time for LADG wassignificantly longer than that for ODG; further, the number of harvestedlymph nodes was significantly lesser in the LADG group than in the ODGgroup. Conclusion: LADG is advantageous over ODG because it results inlesser blood loss, is less painful, and is associated with a low risk of complications. Additional RCTs that compare LADG and ODG andinvestigate the long-term oncological outcomes of LADG are required todetermine the advantages of LADG over ODG.