Totally laparoscopic verse laparoscopic assisted distal gastrostomy for gastric cancer: an update meta-analysis
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Borong Chen1,*, Disheng Xiong2,*, Zirong Pan3,*, Mingyuan Chen4,*, Gang Liu1, Shengjie Wang1, Yongzhi Ye1, Rui Xiao2, Junjie Zeng1, Jiayi Li5 and Zhengjie Huang1,2
1Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
2Department of Gastrointestinal Surgery, First Clinical Medical College of Fujian Medical University, Fuzhou, China
3Department of General Surgery, Xiamen Haicang Hospital, Xiamen, China
4Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou, China
5Department of Medical Oncology, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
*These authors contributed equally to this work
Zhengjie Huang, email: [email protected]
Jiayi Li, email: [email protected]
Keywords: laparoscopic gastrostomy; gastric cancer; meta-analysis
Received: September 18, 2017 Accepted: November 13, 2017 Published: January 03, 2018
Totally laparoscopic distal gastrostomy (TLDG) and laparoscopic- assisted distal gastrostomy (LADG) are the minimally invasive surgical technology for gastric cancer. This study aimed to compare the surgical outcomes of these two methods. Relevant studies were selected through electronic searches of EMBASE, PubMed and Web of Science. In total, 21 non-randomized controlled studies containing 2475 patients in the totally laparoscopic distal gastrostomy and 1889 patients in the laparoscopic-assisted distal gastrostomy were included in this study. And operative time, operative blood loss, retrieved lymph nodes, time to liquid diet (days), postoperative hospital stay and overall complications were pooled and compared using meta-analysis. There were no significant differences between operative time (WMD = 0.38, 95% CI –10.43 –11.18, P = 0.95) and overall complications (RR = 1.09, 95% CI 0.91–1.30, P = 0.36). But totally laparoscopic distal gastrostomy had more advantages in aspects of intraoperative blood loss (WMD = 24.4, 95% CI 12.45–36.36, P < 0.0001), time to liquid diet (days) (WMD = 0.21, 95% CI 0.03–0.40, P = 0.03) and postoperative hospital stay (WMD = 0.72, 95% CI 0.31–1.13, P = 0.0006). Moreover, totally laparoscopic distal gastrostomy had more retrieved lymph nodes (WMD = –1.24, 95% CI–1.90 to–0.58, P = 0.0002). This meta-analysis indicates that totally laparoscopic distal gastrostomy may be a safe, feasible, and favorable surgical technology in terms of less blood loss, faster liquid diet, shorter postoperative hospital stay and more lymph nodes retrieved.
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