Articles identified with criteria for inclusion and exclusion.

<p>Articles identified with criteria for inclusion and exclusion.</p

Laparoscopic versus Open Total Gastrectomy for Gastric Cancer: An Updated Meta-Analysis

<div><p>Objective</p><p>To expand the current knowledge on the feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric cancer in comparison with open total gastrectomy (OTG).</p><p>Background</p><p>Additional studies comparing laparoscopic versus open total gastric resection have been published, and it is necessary to update the meta-analysis of this subject.</p><p>Methods</p><p>Original articles compared LTG and OTG for gastric cancer, which published in English from January 1990 to July 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, proximal resection margin, analgesic medication, first flatus day, first oral intake, postoperative hospital stay, postoperative complications, hospital mortality, 5-year overall survival (OS) and disease-free survival (DFS) were compared using STATA version 10.1.</p><p>Results</p><p>17 studies were selected in this analysis, which included a total of 2313 patients (955 in LTG and 1358 in OTG). LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. The number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar.</p><p>Conclusion</p><p>LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time. There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG. A positive trend was indicated towards LTG. So LTG can be performed as an alternative to OTG by the experienced surgeons in high-volume centers. Whereas, due to the relative small sample size of long-term outcomes and lack of randomized control trials, more studies are required.</p></div

Analysis comparing (A) postoperative complications, (B) postoperative complications under D2 dissection, (C) 5-year OS and (D) 5-year DFS.

<p>Analysis comparing (A) postoperative complications, (B) postoperative complications under D2 dissection, (C) 5-year OS and (D) 5-year DFS.</p

Subgroup-analyses by stage of gastric cancer, study quality, sample size and country of patients.

<p>CI, confidence interval; LTG, laparoscopic total gastrectomy; OTG, open total gastrectomy; RR, relative risks; WMD, weighed mean difference; EGC, early gastric cancer; AGC; advanced gastric cancer; data in bold, significant <i>P</i>-value.</p>a<p>Number of comparisons.</p

Assessment of Quality of Studies.

<p>Assessment of Quality of Studies.</p

Analysis comparing (A) analgesic medication, (B) first flatus day, (C) first oral intake, and (D) postoperative hospital stay.

<p>Analysis comparing (A) analgesic medication, (B) first flatus day, (C) first oral intake, and (D) postoperative hospital stay.</p

Details of the articles included in the meta-analysis.

<p>LTG, laparoscopic total gastrectomy; OTG, open total gastrectomy.</p

Subcategory of postoperative complications comparing LTG with OTG.

<p>CI, confidence interval; LTG, laparoscopic total gastrectomy; OTG, open total gastrectomy; RR, relative risks; WMD, weighed mean difference; data in bold, significant <i>P</i>-value.</p

Characteristics of the articles included in the meta-analysis.

<p>LTG, laparoscopic total gastrectomy; OTG, open total gastrectomy; EGC, early gastic cancer; AGC, advanced gastric cancer; BMI, body mass index; ASA, American Society of Anesthesiology classification.</p

Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.

<p>Analysis comparing (A) operative time, (B) blood loss, (C) harvested lymph nodes, (D) harvested lymph nodes under D2 dissection, and (E) proximal resection margin.</p