| Objective:Gastric cancer is associated with high mortality and morbidity rates worldwide,and East Asian countries such as Korea,Japan,and China in particular exhibit very high morbidity rates related to this disease.Gastrectomy is the optimal treatment for this condition.Laparoscopic gastrectomy has been applied more diffusely in clinic,because of its advantages such as shorter wound length,decreased blood loss,shorter hospitalization duration,and faster recovery.Totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)are 2 versions of laparoscopic total gastrectomy(LTG).LATG has been extensively employed for the removal of gastric tumors.TLTG is a new technique that has rapidly been gaining popularity.It has intracorporeal anastomosis,does not require an auxiliary incision,and a better operative view can be obtained.However,its safety and therapeutic effect remain controversial.In the present study,we aimed to assess the safety and efficacy of TLTG,and compare the short-term outcomes of TLTG and LATG.Methods:We searched for studies comparing TLTG and LATG published up to April2018 from databases such as PubMed and Embase.The study results,including time of surgery,blood loss,anastomosis time,retrieved lymphatic nodes,proximal and distal resection edges,incision length,time to first fluid and soft diet,hospitalization duration,time to first flatus,and postsurgical and anastomotic complications,were compared between the procedures.RevMan 5.3 software(Nordic Cochrane Centre;Denmark)was used to analyze data.To analyze continuous variables,we used a weighted mean difference(WMD).The risk ratio(RR)was employed to assess the dichotomous variables.If the I~2 value was?50%,a fixed effects model was employed,and if the value was>50%,a random effects model was chosen.To avoid publication bias,we used funnel plots.Statistical significance was acknowledged when P values were<0.05.Results:A total of 10 studies(1924 patiens)were included,the study quality was sufficient.1003 patients were included in the TLTG group,whereas 921 patients were included in the LATG group.TLTG led to reduced intraoperative blood loss(WMD,2.40ml;95%CI,-54.47 to 59.27;P<0.01),greater number of retrieved lymphatic nodes(WMD,2.62;95%CI,1.47 to 3.78;P<0.01),decreased hospitalization duration(WMD,-0.57 days;95%CI,-1.00 to-0.14;P<0.01),reduced incision length(WMD,-3.25 cm;95%CI,-6.48 to-0.02;P=0.05),and shorter time to first fluid diet(WMD,-0.23 days;95%CI,-0.41 to-0.04;P<0.05),as compared to LATG.The surgery time(WMD,3.33min;95%CI,-11.72-18.37;P=0.66)and anastomosis time(WMD,3.77 min;95%CI,-2.97-10.51;P=0.27),proximal resection edge(WMD,-0.35 cm;95%CI,-0.96 to 0.25;P=0.25),distal resection edge(WMD,0.27 cm;95%CI,-0.35 to 0.89;P=0.40),time to first soft diet(WMD,-0.46 days;95%CI,-1.44 to 0.52;P=0.35),time to first flatus(WMD,-0.17 days;95%CI,-0.37 to 0.02;P=0.09),overall postsurgical complications(RR,1.00;95%CI,0.83–1.21;P=0.97),and anastomosis-related complications including anastomotic leakage(RR,0.93;95%CI,0.57–1.51;P=0.78),anastomotic stenosis(RR,0.85;95%CI,0.46–1.57;P=0.59),and anastomotic hemorrhage(RR,0.78;95%CI,0.28–2.18;P=0.64)were similar between TLTG and LATG(P>0.05).Conclusions:TLTG is a safe procedure that yields better cosmesis lower invasiveness,and faster recovery as compared to LATG. |
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