Laparoscopic assisted distal gastrectomy for early gastric cancer: Is it an alternative to the open approach?
Accepted 21 August 2008.
Abstract
Objective
This study aims to compare short term outcomes and oncological value of laparoscopy assisted (LADG) and open distal gastrectomy (ODG) in the treatment of early gastric cancer.
Methods
Meta-analysis of 12 studies, including three randomized controlled trials, published between 2000 and 2007, comparing laparoscopy assisted and open distal gastrectomy in 951 patients with early gastric cancer, was done. Outcomes of interest were operative data, lymph node clearance, postoperative recovery complications.
Results
Overall morbidity rate was significantly less with LADG (10.5% versus 20.1%, P=0.003, OR 0.52, CI 0.34–0.8). A mean of 4.61 less number of lymph nodes dissected than ODG (CI −5.96, −3.26 P<0.001) when all studies are included. There was no difference between the two groups in number of lymph nodes dissected when less than D2 lymphadenectomy was done (2.44 nodes less in LADG group, CI −5.52, 0.63; P=0.12). LADG patients had less operative blood loss (mean of 151ml, P<0.001), less time to walking, oral intake and flatus. LADG patients had less length of hospital stay (5.7days, P<0.001), postoperative fever and pain. ODG group showed significantly less operative time. There was no significant difference between the two groups in the incidence of anastomotic complications and wound infection.
Conclusion
LADG is a safe technical alternative to ODG for early gastric cancer with a lower overall complication rate and enhanced postoperative recovery. Endorsing LADG as a better alternative to ODG requires data on long term survival, quality of life and cost effectiveness.
ABSTRACT