Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis.
Gastric cancer
Laparoscopic surgery
Nutrition
Proximal gastrectomy
Surgical outcomes
Total gastrectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
26
02
2019
accepted:
24
12
2019
pubmed:
15
1
2020
medline:
22
5
2021
entrez:
15
1
2020
Statut:
ppublish
Résumé
Laparoscopic proximal gastrectomy (LPG) is regarded as a less invasive surgery than laparoscopic total gastrectomy (LTG) for early gastric cancer located on the proximal side of the stomach. However, whether LPG is more effective than LTG remains unclear. A systematic literature search of studies assessing short-term surgical and nutritional outcomes after LPG and LTG was conducted. A meta-analysis of surgical outcomes (operative time, intraoperative estimated blood loss, postoperative complications, and length of hospital stay) and nutritional outcomes (decrease in body weight, albumin, hemoglobin, total protein, and lymphocyte count) was then performed. All of 11 papers are a retrospective cohort study. Eleven studies reported assessments of the above-mentioned outcomes in 883 patients. There was a trend towards shorter operative time and lower blood loss for LPG compared to LTG though not reaching statistical significance. Other surgical outcomes showed no significant differences. Patients who underwent LTG had a significantly lower body weight (95% confidence interval, 3.01-6.05, [Formula: see text] = 4.53, p < 0.01) and hemoglobin level (95% confidence interval, 1.88-5.87, [Formula: see text] = 3.87, p < 0.01) than patients who underwent LPG at 1 year after surgery. There were no significant differences in other nutritional outcomes. These results indicate LPG had some advantages in postoperative nutrition. However, no significant differences in short-term surgical outcomes were noted between the two operations. Our analysis suggests that LPG may be more beneficial compared with LTG in terms of perioperative and nutritional outcomes for early-stage gastric cancer.
Sections du résumé
BACKGROUND
Laparoscopic proximal gastrectomy (LPG) is regarded as a less invasive surgery than laparoscopic total gastrectomy (LTG) for early gastric cancer located on the proximal side of the stomach. However, whether LPG is more effective than LTG remains unclear.
METHODS
A systematic literature search of studies assessing short-term surgical and nutritional outcomes after LPG and LTG was conducted. A meta-analysis of surgical outcomes (operative time, intraoperative estimated blood loss, postoperative complications, and length of hospital stay) and nutritional outcomes (decrease in body weight, albumin, hemoglobin, total protein, and lymphocyte count) was then performed. All of 11 papers are a retrospective cohort study.
RESULTS
Eleven studies reported assessments of the above-mentioned outcomes in 883 patients. There was a trend towards shorter operative time and lower blood loss for LPG compared to LTG though not reaching statistical significance. Other surgical outcomes showed no significant differences. Patients who underwent LTG had a significantly lower body weight (95% confidence interval, 3.01-6.05, [Formula: see text] = 4.53, p < 0.01) and hemoglobin level (95% confidence interval, 1.88-5.87, [Formula: see text] = 3.87, p < 0.01) than patients who underwent LPG at 1 year after surgery. There were no significant differences in other nutritional outcomes.
CONCLUSIONS
These results indicate LPG had some advantages in postoperative nutrition. However, no significant differences in short-term surgical outcomes were noted between the two operations. Our analysis suggests that LPG may be more beneficial compared with LTG in terms of perioperative and nutritional outcomes for early-stage gastric cancer.
Identifiants
pubmed: 31932938
doi: 10.1007/s00464-019-07352-2
pii: 10.1007/s00464-019-07352-2
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
1061-1069Références
Eur J Gastroenterol Hepatol. 2010 Jun;22(6):669-78
pubmed: 19474750
Gastric Cancer. 2017 Jan;20(1):1-19
pubmed: 27342689
World J Surg. 2013 Mar;37(3):558-64
pubmed: 23254949
Surgery. 2002 Jan;131(1 Suppl):S306-11
pubmed: 11821829
Gastric Cancer. 2010 Nov;13(4):238-44
pubmed: 21128059
Surg Endosc. 2019 Jun;33(6):1757-1768
pubmed: 30203207
Langenbecks Arch Surg. 2012 Jun;397(5):833-40
pubmed: 22398434
World J Surg. 2018 Oct;42(10):3270-3276
pubmed: 29691620
Surg Endosc. 2017 Sep;31(9):3664-3672
pubmed: 28078458
Ann Surg. 2016 Jan;263(1):28-35
pubmed: 26352529
J Am Coll Surg. 2016 Aug;223(2):e7-e13
pubmed: 27157920
World J Surg. 2011 Mar;35(3):617-24
pubmed: 21203759
Br J Surg. 2003 Jul;90(7):850-3
pubmed: 12854112
Surg Endosc. 2016 Sep;30(9):3965-75
pubmed: 26694185
Surg Endosc. 2017 Nov;31(11):4848-4856
pubmed: 28389804
Eur J Surg Oncol. 2018 Dec;44(12):1963-1970
pubmed: 30197164
Ann Surg Oncol. 2017 Jun;24(6):1635-1642
pubmed: 28130623
Anticancer Res. 2016 Sep;36(9):4753-8
pubmed: 27630323
Br J Surg. 2010 Apr;97(4):558-62
pubmed: 20169569
Surg Today. 2019 Jan;49(1):38-48
pubmed: 30159780
World J Surg. 2014 May;38(5):1100-6
pubmed: 24310733
Gastric Cancer. 2013 Jul;16(3):282-9
pubmed: 22821182
BMC Cancer. 2016 Nov 18;16(1):900
pubmed: 27863481
J Korean Surg Soc. 2013 Feb;84(2):123-30
pubmed: 23396494
Surg Laparosc Endosc. 1994 Apr;4(2):146-8
pubmed: 8180768
World J Surg. 2002 Sep;26(9):1150-4
pubmed: 12209245
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S929-35
pubmed: 25986867
Ann Surg Oncol. 2018 Apr;25(4):974-983
pubmed: 29388124
Surg Endosc. 2016 Aug;30(8):3426-36
pubmed: 26511124
Surg Endosc. 2017 Oct;31(10):3961-3969
pubmed: 28342130