Short Term Efficacy Of Total Laparoscopic Versus Open Total Gastrectomy For Gastric Cancer:a Meta Analysis

Objective:Comparison of total laparoscopic total gastrectomy and open total gastrectomy for the treatment of gastric cancer and the safety of the operation? Methods:We searched and collected all randomized controlled trials and retrospective studies of total laparoscopic total gastrectomy and open total gastrectomy for gastric cancer in Pubmed?Embase?Cochrane Central?CNKI?Wanfang database.The time limit was 2017-10.The foreign language database is "Gastric Cancer","laparoscopic","total gastrectomy" and their synonyms as the retrieval words.The Chinese database is "gastric cancer","laparoscopy" and "total gastrectomy" as the retrieval words.The retrieval strategy of combination of subject words and free words is adopted,and the reference documents which have been included in the literature are retrieved manually to ensure the recall rate of the literature.The relevant documents should be included and excluded strictly on the basis of the established inclusion and exclusion criteria.RevMan5.3 software is used for Meta analysis.Results:A total of 7 papers were included in this study,and 1181 patients were included in the study,of which 528 were in group TLTG and 653 in group OTG.The Meta analysis results showed that: compared with OTG group,TLTG group has less bleeding,weighted mean difference(weighted mean difference,WMD =-140.54,95%CI)-192.40 ~-88.68,P<0.05,time of flatus early(WMD =-0.90 95%CI,-1.31 ~-0.50,P<0.05),WMD =-0.86(fast recovery of diet 95%CI-1.51 ~-0.20,P<0.05),postoperative complications(0.45 ~ 1.27 OR=0.71,95%CI,P=0.05)the advantage of lower;but the operation time is longer(8.06 ~ 50.17 WMD =29.11,95%CI,P<0.05);the number of lymph nodes(WMD =-0.22,95%CI,-2.01-1.56,P=0.81),anastomotic complications(OR=0.95 95%CI 0.44 ~ 2.02,P=0.89),hospitalization time after operation(WMD =-2.25,95%CI,-5.15 ~-0.65,P=0.13)the difference was not statistically significant.Conclusion:Compared with open total gastrectomy,total laparoscopic total gastrectomy has less bleeding during operation and faster recovery of gastrointestinal function after operation.It has a minimally invasive advantage,and can achieve the same short-term efficacy and safety as open surgery.But according to the current data analysis is still unable to prove the full laparoscopic total gastrectomy was better than open gastrectomy,and because laparoscopic total gastrectomy surgery is difficult,patients can according to the operation technical level of the disease case,the patient's preference and to choose the appropriate mode of operation.