Efficacy and safety of totally laparoscopic total gastrectomy versus laparoscopic assisted total gastrectomy for gastric carcinoma: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

DING Wei , TAN Yulin , XUE Wenbo , WANG Yibo , XU Yixing ,  XU Xuezhong

Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou, 213002, P.R.China;

Corresponding author：

XU Xuezhong, Email: xxzdoctor@163.com

Keywords：

Laparoscope; Gastric cancer; Gastrectomy; Cohort study; Meta-analysis

DOI：

10.7507/1672-2531.201704101

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Objective To systematically review the efficacy and safety of totally laparoscopic total gastrectomy (TLTG) versus laparoscopic-assisted total gastrectomy (LATG) for patients with gastric cancer. Methods Databases including PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI were searched to collect cohort studies about TLTG vs. LATG for gastric cancer from inception to February 28^th 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of six cohort studies were included, of which 407 cases were in the TLTG group, and 315 cases were in the LATG group. The results of meta-analysis showed that compared with LATG group, patients in TLTG group had shorter operation time (MD=–8.97, 95%CI –16.21 to –1.73, P=0.02), and initial postoperative feeding time (MD=–0.30, 95%CI –0.57 to –0.03, P=0.03). However, the anastomic time, bleeding volume, the number of dissected lymph nodes, proximal resection margin, initial flatus time, postoperative hospital stay, overall postoperative complications, anastomotic fistula, and anastomotic stenosis were similar between two groups (all P values>0.05)． Conclusions Compared with LATG, TLTG has shorter operation and recovery time for patients with gastric cancer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： DING Wei, TAN Yulin, XUE Wenbo, WANG Yibo, XU Yixing, XU Xuezhong. Efficacy and safety of totally laparoscopic total gastrectomy versus laparoscopic assisted total gastrectomy for gastric carcinoma: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(1): 21-28. doi: 10.7507/1672-2531.201704101 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
3.	Kunisaki C, Makino H, Takagawa R, et al. A systematic review of laparoscopic total gastrectomy for gastric cancer. Gastric Cancer, 2015, 18(2): 218-226.
4.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
5.	Jung YJ, Kim DJ, Lee JH, et al. Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVil) following laparoscopic total or proximal gastrectomy - comparison with extracorporeal anastomosis. World J Surg Oncol, 2013, 11: 209.
6.	Kim HS, Kim MG, Kim BS, et al. Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy methods for the surgical treatment of early gastric cancer near the gastroesophageal junction. J Laparoendosc Adv Surg Tech A, 2013, 23(3): 204-210.
7.	Ito H, Inoue H, Odaka N, et al. Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study. Surg Endosc, 2014, 28(6): 1929-1935.
8.	Chen K, He Y, Cai JQ, et al. Comparing the short-term outcomes of intracorporeal esophagojejunostomy with extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. BMC Surg, 2016, 16: 13.
9.	Chen K, Pan Y, Cai JQ, et al. Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol, 2016, 14: 96.
10.	Kim EY, Choi HJ, Cho JB, et al. Totally laparoscopic total gastrectomy versus laparoscopically assisted total gastrectomy for gastric cancer. Anticancer Res, 2016, 36(4): 1999-2003.
11.	Lu X, Hu Y, Liu H, et al. Short-term outcomes of intracorporeal esophagojejunostomy using the transorally inserted anvil versus extracorporeal circular anastomosis during laparoscopic total gastrectomy for gastric cancer: a propensity score matching analysis. J Surg Res, 2016, 200(2): 435-443.
12.	Lee SR, Kim HO, Son BH, et al. Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes. Surg Laparosc Endosc Percutan Tech, 2014, 24(3): 277-282.
13.	Shim JH, Yoo HM, Oh SI, et al. Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric Cancer, 2013, 16(3): 420-427.
14.	Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc, 2009, 23(11): 2624-2630.
15.	Man IM, Suda K, Kikuchi K, et al. Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the tri-staple reloads on the manual ultra handle: a prospective cohort study with historical controls. Surg Endosc, 2015, 29(11): 3304-3312.
16.	Kinoshita T, Oshiro T, Ito K, et al. Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc, 2010, 24(11): 2908-2912.
17.	Chen K, Pan Y, Cai JQ, et al. Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: a single-center 7-year experience. World J Gastroenterol, 2016, 22(12): 3432-3440.
18.	Kosuga T, Hiki N, Nunobe S, et al. Does the single-stapling technique for circular-stapled esophagojejunostomy reduce anastomotic complications after laparoscopic total gastrectomy? Ann Surg Oncol, 2015, 22(11): 3606-3612.
19.	Kim HS, Kim BS, Lee S, et al. Reconstruction of esophagojejunostomies using endoscopic linear staplers in totally laparoscopic total gastrectomy: report of 139 cases in a large-volume center. Surg Laparosc Endosc Percutan Tech, 2013, 23(6): e209-216.
20.	Jeong O, Jung MR, Park YK, et al. Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy. Surg Endosc, 2015, 29(6): 1522-1529.
21.	Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc, 2011, 25(4): 1300-1305.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
3. Kunisaki C, Makino H, Takagawa R, et al. A systematic review of laparoscopic total gastrectomy for gastric cancer. Gastric Cancer, 2015, 18(2): 218-226.
4. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
5. Jung YJ, Kim DJ, Lee JH, et al. Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVil) following laparoscopic total or proximal gastrectomy - comparison with extracorporeal anastomosis. World J Surg Oncol, 2013, 11: 209.
6. Kim HS, Kim MG, Kim BS, et al. Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy methods for the surgical treatment of early gastric cancer near the gastroesophageal junction. J Laparoendosc Adv Surg Tech A, 2013, 23(3): 204-210.
7. Ito H, Inoue H, Odaka N, et al. Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study. Surg Endosc, 2014, 28(6): 1929-1935.
8. Chen K, He Y, Cai JQ, et al. Comparing the short-term outcomes of intracorporeal esophagojejunostomy with extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. BMC Surg, 2016, 16: 13.
9. Chen K, Pan Y, Cai JQ, et al. Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol, 2016, 14: 96.
10. Kim EY, Choi HJ, Cho JB, et al. Totally laparoscopic total gastrectomy versus laparoscopically assisted total gastrectomy for gastric cancer. Anticancer Res, 2016, 36(4): 1999-2003.
11. Lu X, Hu Y, Liu H, et al. Short-term outcomes of intracorporeal esophagojejunostomy using the transorally inserted anvil versus extracorporeal circular anastomosis during laparoscopic total gastrectomy for gastric cancer: a propensity score matching analysis. J Surg Res, 2016, 200(2): 435-443.
12. Lee SR, Kim HO, Son BH, et al. Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes. Surg Laparosc Endosc Percutan Tech, 2014, 24(3): 277-282.
13. Shim JH, Yoo HM, Oh SI, et al. Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric Cancer, 2013, 16(3): 420-427.
14. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc, 2009, 23(11): 2624-2630.
15. Man IM, Suda K, Kikuchi K, et al. Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the tri-staple reloads on the manual ultra handle: a prospective cohort study with historical controls. Surg Endosc, 2015, 29(11): 3304-3312.
16. Kinoshita T, Oshiro T, Ito K, et al. Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc, 2010, 24(11): 2908-2912.
17. Chen K, Pan Y, Cai JQ, et al. Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: a single-center 7-year experience. World J Gastroenterol, 2016, 22(12): 3432-3440.
18. Kosuga T, Hiki N, Nunobe S, et al. Does the single-stapling technique for circular-stapled esophagojejunostomy reduce anastomotic complications after laparoscopic total gastrectomy? Ann Surg Oncol, 2015, 22(11): 3606-3612.
19. Kim HS, Kim BS, Lee S, et al. Reconstruction of esophagojejunostomies using endoscopic linear staplers in totally laparoscopic total gastrectomy: report of 139 cases in a large-volume center. Surg Laparosc Endosc Percutan Tech, 2013, 23(6): e209-216.
20. Jeong O, Jung MR, Park YK, et al. Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy. Surg Endosc, 2015, 29(6): 1522-1529.
21. Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc, 2011, 25(4): 1300-1305.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of totally laparoscopic total gastrectomy versus laparoscopic assisted total gastrectomy for gastric carcinoma: a meta-analysis

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