Short-term Evaluation of Laparoscopy-assisted Distal Gastrectomy for Predictive Early Gastric Cancer A Meta-analysis of Randomized Controlled Trials

Background: In recent decade, laparoscopy-assisted distal gastrectomy (LADG) has been introduced to treatment of early gastric cancer (EGC). Previous meta-analyses included the randomized controlled trial (RCT) apparently contaminated with advanced gastric cancer. Besides, more RCTs enrolling the predictive EGC are available. The present meta-analysis was aimed to compare LADG with open distal gastrectomy (ODG) by updating the literature search and repooling the RCTs of only predictive EGC with improved methodology. Methods: Comprehensive search of PubMed, EmBase, and multiple websites of clinical trials registration and oncologic groups were performed. Only short-term outcomes measures were considered to meta-analysis. The RevMan 5.0 was used for pooled estimates. Results: Six RCTs of 629 patients totally were included for meta-analysis. Comparing LADG to ODG, results found less postoperative early morbidity (risk ratios = 0.61, P = 0.01), similar mortality (risk diffrence = 0,01, P = 0.32), prolonged operation time [mean difference (MD) 86.64 min, P < 0.00001], decreased intraoperative blood loss (MD = -108.33 mL, P = 0.001), decreased number of harvested lymph nodes (MD = -4.88, P < 0.00001), forwarded time to oral intake (MD = -0.48d, P = 0.32), and shortened hospital stay (M D = -2.03d, P = 0.14). Conclusions: LADG could bring the patients with EGC slight benefits by decreasing intraoperative blood loss and postoperative early morbidity, but unfavorably, might increase the operation time and decease the number of harvested lymph nodes. The long-term survival benefit is still eager to be proven by further Outcomes of RCTs.