| Objective:To compare the short-term and long-term outcome totally laparoscopic and laparoscopic-assisted total gastrectomy for gastric cancer.A systematic review and meta-analysis based on existing literatures were conducted for these two surgical methods.Method:The clinical data of 1015 cases who had received totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)was collected by IMIGASTRIC(a Multi-center study initiated by Italy)from March 2012 to December 2015.864 patients underwent LATG and 151 patients underwent TLTG.The propensity score matching was based on sex,age,BMI and ASA score,comorbidities,tumor size and AJCC staging of these two groups.After propensity score matching,119 patients in TLTG and 238 patients in LATG were identified.Perioperative outcome and overall survival were compared between the two groups.Furthermore,a systematic review and meta-analysis were conducted.Result:There were comparable baseline characteristics between patients in totally laparoscopic total gastrectomy group(TLTG)and in laparoscopic-assisted total gastrectomy group(LATG).Compared with LATG,TLTG had advantages on surgical incision length,first flatus and diet initiation(p(27)0.05),but there are no significant differences in lymph node retrieval,operation time,estimated blood loss,postoperative ambulation time,postoperative hospital stay and postoperative hospital stay(p(29)0.05).The 3-year survival rate was 78.5% and 74.8% for patients in TLTG and patients in LATG(p(29)0.05),and the 5-year survival rate was 40.6% and 42% respectively.The meta-analysis revealed no significant differences in the operation time,time to first flatus,hospital stays,overall and anastomosis-related complications among these two groups,but TLTG had slight advantages on estimated blood loss,lymph node retrieval and diet initiation.Conclusions : TLTG is a feasible choice for gastric cancer patients,with comparable results to the LATG approach. |
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