Effects of Laparoscopic versus Open Surgery for Advanced Gastric Cancer after Neoadjuvant Chemotherapy: A Meta-Analysis.

OBJECTIVE

To evaluate the efficacy of laparoscopy and laparotomy after neoadjuvant chemotherapy in the treatment of advanced gastric cancer by meta-analysis.

METHODS

Cochrane Library, Embase, and PubMed were searched by computer until December 1, 2021. Literature was screened according to inclusion and exclusion criteria, and relevant data were extracted for meta-analysis using RevMan 5.3.

RESULTS

A total of 1027 patients from 11 literature studies were included in this study, including 413 patients in the laparoscopic group and 614 patients in the open group. Meta-analysis showed that the laparoscopic group had less intraoperative bleeding (SMD = -1.11; 95% CI: -1.75-0.47; =0.0006), early postoperative exhaust (SMD = -0.45; 95% CI: -0.70-0.20; =0.0004), and shorter postoperative hospital stay (SMD = 0.97; 95% CI: 1.69∼0.26; =0.008), but had longer the operation time (SMD = 0.65; 95% CI: 0.52∼0.79; < 0.00001). There was no significant difference in the number of lymph nodes dissected during operation (SMD = -0.45; 95% CI: -0.42-0.19; =0.45), the incidence of surgical complications 30 days after operation (OR = 0.78; 95% CI: 0.53∼1.13; =0.19), time of first defecation (MD = 0.00; 95% CI: -0.10∼0.10; =0.98), and time of first postoperative feeding (MD = -0.05; 95% CI: -0.22∼0.12; =0.54) between the two groups. For long-term prognosis, there was no significant difference in the 3-year overall survival rate after operation between the two groups (RR = 0.84; 95% CI: 0.63-1.12; =0.23).

CONCLUSION

Compared with the open stomach cancer surgery, laparoscopic gastric cancer surgery has less intraoperative blood loss, shorter hospitalization time, and advantages such as early rehabilitation, postoperative complications rate, and long-term survival, which confirmed the validity and security of the laparoscopic surgery.