Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer

Preliminary study for a multicenter prospective KLASS07 trial

Hyui Eun Jin, Min Seo Kim, Chang Min Lee, Ji Ho Park, Chang In Choi, Han Hong Lee, Jae Seok Min, Ye Seob Jee, Jeong Oh, Hyundong Chae, Sung Il Choi, Yoon Taek Lee, Jong Han Kim, Hua Huang, Sungsoo Park

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. Methods: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). Results: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. Conclusions: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).

Original languageEnglish
JournalEuropean Journal of Surgical Oncology
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Gastrectomy
Multicenter Studies
Stomach Neoplasms
Meta-Analysis
Postoperative Pain
PubMed
Analgesics
Length of Stay
Odds Ratio
Economics
Quality of Life
Databases
Prospective Studies
Confidence Intervals
Diet
Morbidity

Keywords

  • Anastomosis
  • Gastric cancer
  • Laparoscopically assisted distal gastrectomy (LADG)
  • Meta-analysis
  • Postoperative complications
  • Totally laparoscopic distal gastrectomy (TLDG)

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer : Preliminary study for a multicenter prospective KLASS07 trial. / Jin, Hyui Eun; Kim, Min Seo; Lee, Chang Min; Park, Ji Ho; Choi, Chang In; Lee, Han Hong; Min, Jae Seok; Jee, Ye Seob; Oh, Jeong; Chae, Hyundong; Choi, Sung Il; Lee, Yoon Taek; Kim, Jong Han; Huang, Hua; Park, Sungsoo.

In: European Journal of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalReview article

Jin, Hyui Eun ; Kim, Min Seo ; Lee, Chang Min ; Park, Ji Ho ; Choi, Chang In ; Lee, Han Hong ; Min, Jae Seok ; Jee, Ye Seob ; Oh, Jeong ; Chae, Hyundong ; Choi, Sung Il ; Lee, Yoon Taek ; Kim, Jong Han ; Huang, Hua ; Park, Sungsoo. / Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer : Preliminary study for a multicenter prospective KLASS07 trial. In: European Journal of Surgical Oncology. 2019.
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abstract = "Background: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. Methods: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95{\%} confidence intervals (c.i.). Results: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. Conclusions: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).",
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author = "Jin, {Hyui Eun} and Kim, {Min Seo} and Lee, {Chang Min} and Park, {Ji Ho} and Choi, {Chang In} and Lee, {Han Hong} and Min, {Jae Seok} and Jee, {Ye Seob} and Jeong Oh and Hyundong Chae and Choi, {Sung Il} and Lee, {Yoon Taek} and Kim, {Jong Han} and Hua Huang and Sungsoo Park",
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T1 - Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer

T2 - Preliminary study for a multicenter prospective KLASS07 trial

AU - Jin, Hyui Eun

AU - Kim, Min Seo

AU - Lee, Chang Min

AU - Park, Ji Ho

AU - Choi, Chang In

AU - Lee, Han Hong

AU - Min, Jae Seok

AU - Jee, Ye Seob

AU - Oh, Jeong

AU - Chae, Hyundong

AU - Choi, Sung Il

AU - Lee, Yoon Taek

AU - Kim, Jong Han

AU - Huang, Hua

AU - Park, Sungsoo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. Methods: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). Results: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. Conclusions: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).

AB - Background: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. Methods: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). Results: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. Conclusions: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).

KW - Anastomosis

KW - Gastric cancer

KW - Laparoscopically assisted distal gastrectomy (LADG)

KW - Meta-analysis

KW - Postoperative complications

KW - Totally laparoscopic distal gastrectomy (TLDG)

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