The influence of laparoscopy-assisted gastrectomy versus open gastrectomy to long-term survival for early gastric cancer: an updated meta-analysis based on randomized controlled trials

Abstract Background There is a controversy for the therapeutic effect of laparoscopy-assisted gastrectomy (LADG) and open gastrectomy for a long time. The meta-analysis in this article evaluates and compares the effectiveness of these two treatments to patients' long-term survival. Method We searched MEDLINE (PubMed), EMBASE (Ovid) and the Cochrane Library and identified all qualified researches from January 2002 to January 2020. The statistic analysis is performed by Revman 5.3 and Version 3 Comprehensive Meta-analysis. Through the results, we compared the advantages and long-term survival of LADG and ODG. Result According to the result of 8 randomized controlled trials which involves 2650 patients with early gastric cancer, compared with ODG, LAGD has longer surgery time (MD=78.11,95%CI=59.14-97.07,P<0.00001), less blood loss (MD=-100.59,95%CI=-127.71--73.46,P<0.00001), a shorter incision (MD=-12.25,95%CI=-13.18--11.31,P<0.00001), shorter time to start the first time of flatus (MD=-0.66,95%CI=-1.01--0.32,P=0.0001), shorter hospital stay (MD=-0.94,95%CI=-1.66--0.22,P=0.01), and lower frequency of analgesic utilization (MD=-1.69,95%CI=-2.18--1.21,P<0.00001). However, there is no statistical difference between ODG and LAGD on the number of harvested lymph nodes, time of the first meal, short-term surgical complications, cancer recurrence rate, and long-term survival rate. Conclusion According to the result of meta-analysis, compared with ODG, LADG has a significant advantage in blood loss in surgery, early rehabilitation, scar development, management of postoperative pain, etc. Meanwhile, LADG and ODG have the same performance on long-term survival. Therefore, we believe LADG is a safe and effective replacement of ODG for early gastric cancer.