Laparoscopic versus open distal gastrectomy leads to better oncological outcomes in gastric cancer: Study

Netherlands: A team of researchers led by Nadia A.G. Hakkenbrak conducted a study that showed that less perioperative blood loss, faster patient recovery, and fewer complications are all advantages of laparoscopic distal gastrectomy (LDG). Furthermore, LDG is oncologically appropriate in terms of lymph node yield, resection adequacy, and survival. The findings of this study were published in the Surgery journal.

For gastric cancer, LDG with sufficient lymph node dissection is becoming more popular across the world. This surgical method has been the subject of several randomized studies. The goal of this meta-analysis is to provide an updated summary of the short-term, long-term, and oncological outcomes of laparoscopic distal gastrectomy versus open distal gastrectomy (ODG).

A thorough search of the Medline, Embase, and Cochrane databases was done for this investigation, which included randomized clinical studies comparing LDG versus open distal gastrectomy. Surgical results, postoperative recovery, complications, mortality, appropriateness of resection, and long-term survival were all evaluated in the studies.

The results of this study stated as follow:

1. There were 2,347 papers found in total, with 22 randomized clinical trials chosen for study.

2. The LDG procedure resulted in much-reduced blood loss and longer operating duration.

3. Patients who received LDG had a quicker recovery of bowel function, a shorter hospital stay, and fewer problems, with no difference in death rates.

4. Both groups had equivalent lymph node yield and resection margins.

5. Because of the wide range of follow-up durations, survival results could not be assessed.

In conclusion, laparoscopic surgical procedures for distal gastrectomy in gastric cancer patients are gaining popularity across the world, although acceptance and implementation remain slow. According to the findings of this meta-analysis, laparoscopic distal gastrectomy is oncologically appropriate in terms of resection quality, lymph node yield, and survival. Patients who get LDG may have a lower risk of surgical complications and a shorter recovery time. The findings of this study support the use of LDG in centers with sufficient expertise and experience.

Reference:

Nadia A.G. Hakkenbrak, Elise P. Jansma, N. van der Wielen, Donald L. van der Peet, Jennifer Straatman, Laparoscopic versus open distal gastrectomy for gastric cancer: A systematic review and meta-analysis, Surgery, 2022, https://doi.org/10.1016/j.surg.2021.11.035.