Background
Methods
Search strategy
Eligibility criteria
Data extraction and quality assessment
Subgroup analysis
Statistical analysis
Results
Studies selected
Study characteristics and quality
Author | Region | Study design | Year | Study period | Sample size | Level of lymphadenectomy | Surgical extension | Reconstruction | Conversion (%) | ||
---|---|---|---|---|---|---|---|---|---|---|---|
LG | RG | LG | RG | ||||||||
Pugliese | Italy | OCS (R) | 2010 | 2000–2009 | 48 | 16 | D2 | D | R-Y | 3(6) | 2(12) |
Kim MC | Korea | OCS (P) | 2010 | 2007–2008 | 11 | 16 | D1 + β, D2 | D | B-I, B-II | 0 | 0 |
Kim KM | Korea | OCS (P) | 2012 | 2005–2010 | 861 | 436 | D1 + α/β, D2 | D, T | B-I, B-II, R-Y | NR | NR |
Son SY | Korea | OCS (R) | 2012 | 2007–2011 | 42 | 21 | D1 + β, D2 | D, P, T | B-I, B-II, R-Y | NR | NR |
Kang | Korea | OCS (P) | 2012 | 2008–2011 | 282 | 100 | D1 + α/β, D2 | D, T | B-I, B-II, R-Y | E | 0 |
Zhang | China | OCS (R) | 2012 | 2009–2011 | 70 | 97 | D2 | D, P, T | B-I, B-II, R-Y | 0 | 0 |
Hyun | Korea | OCS (P) | 2013 | 2009–2010 | 83 | 38 | D1 + α/β, D2 | D, T | B-I, B-II, R-Y | 0 | 0 |
Son T | Korea | OCS (R) | 2014 | 2003–2010 | 58 | 51 | D2 | T | R-Y | 0 | 0 |
Noshiro | Japan | OCS (P) | 2014 | 2010–2012 | 160 | 21 | D1 + α/β, D2 | D | B-I, B-II, R-Y | 0 | 0 |
Huang | Taiwan | OCS (P) | 2014 | 2008–2014 | 73 | 72 | D1 + α/β, D2 | D, T | B-I, R-Y | NR | NR |
Zhou | China | OCS (R) | 2014 | 2010–2013 | 394 | 120 | D1 + α/β, D2 | D, P, T | B-I, B-II, R-Y | E | E |
Liu | China | OCS (R) | 2014 | 2012–2013 | 100 | 100 | D2 | D, P, T | B-I, B-II, R-Y | 1(1) | 0 |
Lee | Korea | OCS (P) | 2015 | 2003–2010 | 267 | 133 | D2 | D | B-I, B-II, R-Y | NR | NR |
Han | Korea | OCS (R) | 2015 | 2008–2013 | 68 | 68 | D1 + β | PPG | GG | 0 | 0 |
Park | Korea | OCS (P) | 2015 | 2009–2011 | 612 | 145 | D1 + α/β | D, T | B-I, B-II, R-Y | 10(1.6) | 3(2.0) |
Suda | Japan | OCS (R) | 2015 | 2009–2012 | 438 | 88 | D1 + α/β, D2 | D, T | B-I, B-II, R-Y | 0 | 0 |
Kim HI | Korea | OCS (P) | 2016 | 2011–2012 | 185 | 185 | D1 + α/β, D2 | D, T | B-I, B-II, R-Y | 2(1.1) | 1(0.5) |
Shen | China | OCS (R) | 2016 | 2011–2014 | 330 | 93 | D1 + α/β, D2 | D, T | B-I, B-II, R-Y | 0 | 0 |
Cianchi | Italy | OCS (R) | 2016 | 2008–2015 | 41 | 30 | D1 + α/β, D2 | D | B-II, R-Y | 0 | 0 |
Author | Selection (Out of 4) | Comparability (Out of 2) | Outcomes (Out of 3) | Total (Out of 9) | |||||
---|---|---|---|---|---|---|---|---|---|
①
|
②
|
③
|
④
|
⑤
|
⑥
|
⑦
| |||
Pugliese | * | * | * | * | ** | * | * | * | 9 |
Kim MC | * | * | * | * | * | * | 6 | ||
Kim KM | * | * | * | * | * | * | 6 | ||
Son SY | * | * | * | * | ** | * | 7 | ||
Kang | * | * | * | * | * | * | 6 | ||
Zhang | * | * | * | * | ** | * | 7 | ||
Hyun | * | * | * | * | * | * | 6 | ||
Son T | * | * | * | * | ** | * | * | * | 9 |
Noshiro | * | * | * | * | ** | * | 7 | ||
Huang | * | * | * | * | ** | * | 7 | ||
Zhou | * | * | * | * | ** | * | * | * | 9 |
Liu | * | * | * | * | ** | * | 7 | ||
Lee | * | * | * | * | * | * | * | * | 8 |
Han | * | * | * | * | ** | * | * | * | 9 |
Park | * | * | * | * | * | * | 6 | ||
Suda | * | * | * | * | * | * | * | 7 | |
Kim HI | * | * | * | * | * | * | 6 | ||
Shen | * | * | * | * | ** | * | 7 | ||
Cianchi | * | * | * | * | * | * | 6 |
Intraoperative effects and postoperative recovery
Outcomes | No. of studies | Sample size | Heterogeneity (P, I
2
) | Overall effect size | 95% CI of overall effect |
P
| |
---|---|---|---|---|---|---|---|
LG | RG | ||||||
Conversion | 4 | 16 | 6 | 0.68, 0% | RR =0.88 | 0.36 ~ 2.17 | 0.78 |
Operation time (min) | 19 | 4123 | 1830 | <0.001, 88% | WMD = −49.05 | -58.18 ~ −39.91 | <0.01 |
Blood loss (mL) | 18 | 4055 | 1762 | <0.001, 93% | WMD =24.38 | 12.32 ~ 36.43 | <0.01 |
Time to first flatus (days) | 9 | 1231 | 713 | <0.001, 74% | WMD =0.09 | -0.10 ~ 0.27 | 0.36 |
Time to oral intake (days) | 9 | 2055 | 1096 | 0.67, 0% | WMD =0.23 | 0.13 ~ 0.34 | <0.01 |
Hospital stay (days) | 19 | 4123 | 1830 | <0.001, 82% | WMD =0.35 | -0.25 ~ 0.95 | 0.25 |
Overall complications | 19 | 4123 | 1830 | 0.82, 0% | RR =0.96 | 0.82 ~ 1.13 | 0.65 |
Surgical complications | 17 | 3234 | 1552 | 0.52, 0% | RR =0.87 | 0.72 ~ 1.05 | 0.15 |
Medical complications | 12 | 2137 | 907 | 0.82, 0% | RR =1.34 | 0.75 ~ 2.40 | 0.32 |
Reoperation | 7 | 1796 | 789 | 0.35, 11% | RR =0.69 | 0.29 ~ 1.62 | 0.39 |
Mortality | 7 | 2131 | 838 | 0.91, 0% | RR =0.67 | 0.26 ~ 1.74 | 0.41 |
Retrieved lymph nodes | 17 | 3229 | 1585 | <0.001, 86% | WMD = −1.44 | -3.26 ~ 0.37 | 0.12 |
Proximal margin (cm) | 9 | 2006 | 1024 | 0.21, 26% | WMD = −0.14 | -0.36 ~ 0.07 | 0.18 |
Distal margin (cm) | 8 | 1948 | 973 | <0.001, 81% | WMD =0.09 | -0.46 ~ 0.65 | 0.74 |
Recurrence | 3 | 500 | 187 | 0.39, 0% | RR =1.09 | 0.57 ~ 2.05 | 0.80 |
Cost (USD) | 4 | 390 | 384 | <0.001, 93% | WMD = −3944.8 | -4943.5 ~ −2946.2 | <0.01 |
Morbidity and mortality
Author | Group | Reoperation | Death |
---|---|---|---|
Pugliese | LG | Enterocutaneous leak (n = 1) | Severe bleeding due to hepatic failure (n = 1) |
RG | NC | Hemorrhagic stroke (n = 1) | |
Kim KM | LG | Leak-related (n = 4)a
| Leak-related (n = 2)a
|
RG | Leak-related (n = 6)a
| NC | |
RG | Leakage and obstruction (n = 5) | NC | |
Lee | LG | Anastomotic leakage (n = 1) | NC |
RG | Anastomotic leakage (n = 1), anastomotic bleeding (n = 1) | Anastomotic bleeding (n = 1) | |
Huang | LG | NC | Duodenal stump leakage (n = 1) |
RG | NC | Gastrojejunostomy leakage (n = 1) | |
Han | LG | Intra-abdominal bleeding due to liver capsular injury (n = 1) | NC |
Park | LG | NC | Immediate postoperative bleeding (n = 1), mesenteric infarction (n = 1), septic shock caused by afferent loop syndrome (n = 1) |
Cianchi | LG | NC | Duodenal stump leakage with peritonitis and sepsis (n = 1), acute myocardial infarction (n = 1) |
RG | Intestinal occlusion (n = 1) | Cerebral vascular accident (n = 1) |
Oncologic outcomes and long-term survival
Author | Group | Stage | Chemotherapy | Follow-up (mo) | Recurrence | Survival (%) |
---|---|---|---|---|---|---|
Pugliese | LG | Any TNM0
| T3 or any TN+
| 53 (3–112) | 8a
| 3y–OS: 85; 5y–OS: 83&
|
RG | 28 (2–44) | 4a
| 3y–OS: 78&
| |||
Son T | LG | Any TNM0
| NR | 70 | 3b
| 5y–DFS: 91.2; 5y–OS: 91.1 |
RG | 3b
| 5y–DFS: 90.2; 5y–OS: 89.5 | ||||
Zhou | LG | Any TNM0
| Routinely#
| 17(3–41) | 28 | 1, 2, 3-OS: 87.3, 77.1, 69.9 3y–OS N−:82.6, 3y–OS N+:60.3 |
RG | 5 | 1, 2, 3-OS: 90.2, 78.1, 67.8 3y–OS N−: 84.4, 3y–OS N+: 57.5 | ||||
Lee | LG | Any TNM0
| NR | 75 | NR | NSD |
RG | ||||||
Han | LG | cT1-2N0M0
| 3 cases (4.4%)$
| 19.3 | 0 | NSD |
RG | 3 cases (4.4%)$
| 22.7 | 0 |
Total cost
Subgroup analysis of distal or total gastrectomy
Outcomes | No. of studies | Sample size | Heterogeneity (P, I
2
) | Overall effect size | 95% CI of overall effect |
P
| |
---|---|---|---|---|---|---|---|
LG | RG | ||||||
Operation time (min) | |||||||
DG | 8 | 1635 | 453 | <0.001, 78% | WMD = −57.08 | −68.62 ~ −45.54 | <0.01 |
TG | 5 | 448 | 166 | 0.004, 74% | WMD = −42.62 | −66.72 ~ −18.52 | <0.01 |
Blood loss (mL) | |||||||
DG | 8 | 1635 | 453 | <0.001, 77% | WMD =19.27 | 3.86 ~ 34.68 | 0.01 |
TG | 5 | 448 | 166 | 0.54, 0% | WMD =23.77 | 1.97 ~ 45.56 | 0.03 |
Time to oral intake (days) | |||||||
DG | 3 | 344 | 116 | 0.49, 0% | WMD =0.18 | 0.00 ~ 0.36 | 0.05 |
TG | 3 | 251 | 100 | 0.71, 0% | WMD = −0.18 | −0.55 ~ 0.20 | 0.36 |
Hospital stay (days) | |||||||
DG | 8 | 1635 | 453 | <0.001, 92% | WMD =0.52 | −0.69 ~ 1.74 | 0.40 |
TG | 5 | 448 | 166 | 0.75, 0% | WMD =0.28 | −0.80 ~ 1.36 | 0.61 |
Overall complications | |||||||
DG | 8 | 1635 | 453 | 0.86, 0% | RR =1.19 | 0.83 ~ 1.71 | 0.34 |
TG | 4 | 330 | 140 | 0.49, 0% | RR =1.32 | 0.80 ~ 2.18 | 0.27 |
Mortality | |||||||
DG | 4 | 942 | 213 | 0.84, 0% | RR =0.84 | 0.21 ~ 3.30 | 0.80 |
TG | 2 | 194 | 81 | 0.55, 0% | RR =0.15 | 0.02 ~ 1.41 | 0.10 |
Retrieved lymph nodes | |||||||
DG | 8 | 1635 | 453 | <0.001, 92% | WMD = −2.10 | −5.90 ~ 1.70 | 0.28 |
TG | 5 | 448 | 166 | 0.63, 0% | WMD = −2.51 | −4.83 ~ −0.19 | 0.03 |
Subgroup analysis of weight influence
Outcomes | No. of studies | Sample size | Heterogeneity (P, I
2
) | Overall effect size | 95% CI of overall effect |
P
| |
---|---|---|---|---|---|---|---|
LG | RG | ||||||
Operation time (min) | |||||||
non-overweight | 2 | 232 | 127 | 0.06, 72% | WMD = −37.63 | −62.82 ~ −12.43 | <0.01 |
overweight | 2 | 118 | 44 | 0.008, 86% | WMD = −28.58 | −79.11 ~ 21.94 | 0.27 |
Blood loss (mL) | |||||||
non-overweight | 2 | 232 | 127 | 0.11, 60% | WMD =0.90 | −13.44 ~ 15.25 | 0.90 |
overweight | 2 | 118 | 44 | 0.03, 80% | WMD =39.84 | −41.71 ~ 121.39 | 0.34 |
Retrieved lymph nodes | |||||||
non-overweight | 2 | 232 | 127 | 0.34, 0% | WMD = −1.88 | −4.78 ~ 1.01 | 0.20 |
overweight | 2 | 118 | 44 | 0.03, 79% | WMD =4.32 | −4.10 ~ 12.74 | 0.31 |