Background
Methods
Search strategy
Eligibility criteria
Data extraction and quality assessment
Statistical analysis
Results
Studies selected
Study characteristics and quality
Author
|
Nation
|
Year
|
Study period
|
Sample Size
|
Level of Lymphadenectomy
|
Reconstruction
| |
---|---|---|---|---|---|---|---|
LADG
|
TLDG
| ||||||
Song [16] | Korea | 2008 | 2005 to 2006 | 20 | 20 | D1 + β, D2 | B-I, B-II, R-Y |
Ikeda [17] | Japan | 2009 | 2005 to 2007 | 24 | 56 | D1 + β, D2 | B-I, R-Y |
Kinoshita [18] | Japan | 2011 | 2007 to 2009 | 41 | 42 | D1 + α/β, D2 | B-I |
Kim MG [19] | Korea | 2011 | 2009 to 2010 | 328 | 239 | D2 | B-I |
Lee [20] | Korea | 2012 | 2004 to 2011 | 269 | 130 | D1 + α/β, D2 | B-II |
Kim DG [21] | Korea | 2013 | 2009 to 2012 | 106 | 60 | D1 + β, D2 | B-I |
Kim HG [22] | Korea | 2013 | 2005 to 2012 | 136 | 111 | D1 + β, D2 | B-I, B-II |
Choi [23] | Korea | 2013 | 2007 to 2012 | 35 | 37 | D1 + α/β, D2 | B-I, B-II, R-Y |
Chen [24] | China | 2014 | 2004 to 2013 | 93 | 147 | D2 | B-I, B-II |
Zhang [25] | China | 2014 | 2012 to 2013 | 25 | 11 | D2 | B-II |
Han [26] | Korea | 2014 | 2005 to 2013 | 77 | 134 | D1 + α/β, D2 | B-I, B-II, R-Y |
Kanaji [27] | Japan | 2014 | 2010 to 2012 | 74 | 40 | D1 + α/β, D2 | B-I, B-II, R-Y |
Author
|
Selection (out of 4)
|
Comparability (out of 2)
|
Outcomes (out of 3)
|
Total (out of 9)
| |||||
---|---|---|---|---|---|---|---|---|---|
Representativeness of exposed cohort
|
Selection of non-exposed cohort
|
Ascertainment of exposure
|
Outcome not present at the start of the study
|
Assessment of outcomes
|
Length of follow-up
|
Adequacy of follow-up
| |||
Song | * | * | * | * | ** | * | 7 | ||
Ikeda | * | * | * | * | ** | * | 7 | ||
Kinoshita | * | * | * | * | ** | * | * | 8 | |
Kim MG | * | * | * | * | * | * | 6 | ||
Lee | * | * | * | * | ** | * | 7 | ||
Kim DG | * | * | * | * | * | * | * | 7 | |
Kim HG | * | * | * | * | * | * | 6 | ||
Choi | * | * | * | * | ** | * | 7 | ||
Chen | * | * | * | * | ** | * | * | * | 9 |
Zhang | * | * | * | * | ** | * | 7 | ||
Han | * | * | * | * | * | * | 6 | ||
Kanaji | * | * | * | * | ** | * | 7 |
Intraoperative effects
Outcomes
|
Number of studies
|
Sample size
|
Heterogeneity (
P, I
2)
|
Overall effect size
|
95% CI of overall effect
|
P
value
| |
---|---|---|---|---|---|---|---|
LADG
|
TLDG
| ||||||
Operation time (min) | 12 | 1,228 | 1,027 | <0.01, 97% | WMD = 7.59 | −8.08 to 23.25 | 0.34 |
Blood loss (ml) | 10 | 764 | 677 | <0.01, 92% | WMD = 36.92 | 13.43 to 60.41 | <0.01 |
Retrieved lymph nodes | 10 | 1,045 | 833 | 0.23, 23% | WMD = −1.01 | −2.07 to 0.07 | 0.06 |
Proximal margin (cm) | 8 | 982 | 874 | <0.01, 96% | WMD = −0.48 | −1.28 to 0.31 | 0.23 |
Distal margin (cm) | 5 | 846 | 647 | <0.01, 74% | WMD = −0.51 | −1.06 to 0.05 | 0.07 |
Analgesics use (times) | 5 | 764 | 491 | <0.01, 84% | WMD = 0.52 | −0.17 to 1.21 | 0.14 |
Time to first flatus (days) | 10 | 882 | 763 | <0.01, 96% | WMD = 0.23 | −0.13 to 0.59 | 0.21 |
Time to liquid diet (days) | 6 | 292 | 333 | <0.01, 92% | WMD = 0.30 | −0.15 to 0.75 | 0.19 |
Time to soft diet (days) | 5 | 571 | 522 | <0.01, 81% | WMD = 0.60 | 0.04 to 1.17 | 0.04 |
Hospital stay (days) | 12 | 1228 | 1027 | <0.01, 80% | WMD = 0.68 | 0.17 to 1.18 | <0.01 |
Overall complications | 12 | 1228 | 1027 | 0.41, 3% | RR = 0.97 | 0.75 to 1.27 | 0.85 |
Postoperative outcome
Author
|
Group
|
Number
|
Total event
|
Specified complications
|
---|---|---|---|---|
Song | LADG | 20 | 3 | Wound infection × 1,ileus × 1,abdominal abscess × 1 |
TLDG | 20 | 1 | Abdominal bleeding × 1 | |
Ikeda | LADG | 24 | 3 | Wound infection × 1, atelectasis × 2 |
TLDG | 56 | 3 | Wound infection × 2,pancreatic leakage × 1 | |
Kinoshita | LADG | 41 | 6 | Wound infection × 2,abdominal abscess × 1, anastomotic hemorrhage × 1, anastomotic stricture × 1, pancreatitis × 1 |
TLDG | 42 | 6 | Wound infection × 2,abdominal abscess × 2, pancreatitis × 1, cholecystitis × 1 | |
Kim MG | LADG | 328 | 21 | Wound complications × 11, anastomosis leakage × 2, anastomosis stenosis × 1, anastomosis bleeding × 2, abdominal abscess × 4, abdominal bleeding × 1 |
TLDG | 239 | 9 | Wound complications × 2, anastomosis leakage × 1, anastomosis bleeding × 1,abdominal abscess × 3, abdominal bleeding × 1, paralytic ileus × 1 | |
Lee | LADG | 269 | 21 | Duodenal stump leakage × 10, anastomosis leakage × 3, abdominal bleeding × 2, afferent loop obstruction × 1, gastric stasis × 5 |
TLDG | 130 | 11 | Duodenal stump leakage × 3, anastomosis leakage × 1, abdominal bleeding × 4, afferent loop obstruction × 1, gastric stasis × 2 | |
Kim DG | LADG | 106 | 6 | Anastomosis leakage × 1,fluid collection × 4, respiratory infection × 1 |
TLDG | 60 | 8 | Anastomosis leakage × 1,fluid collection × 2, respiratory infection × 1, wound seroma × 1, delayed gastric emptying × 2, trocar site hernia × 1 | |
Kim HG | LADG | 136 | 20 | Anastomotic leakage × 6, abdominal abscess × 2, wound problem × 4, abdominal bleeding × 2, pancreatitis × 1, lung complication × 2, hepatic complication × 1, outlet obstruction × 1, |
TLDG | 111 | 21 | Anastomotic leakage × 3, abdominal abscess × 2, wound problem × 2, abdominal bleeding × 4, luminal bleeding × 2, ileus × 2, pancreatitis × 3, hepatic complication × 3, heart complication × 2, stasis × 2 | |
Choi | LADG | 35 | 7 | Wound infection × 1, stasis × 2, leakage × 1, pulmonary complication × 2, renal complication × 1, cerebral infarction × 1 |
TLDG | 37 | 13 | Wound infection × 1, abdominal abscess × 1, leakage × 4, abdominal bleeding × 1, pancreatitis × 2, pulmonary complication × 2, hepatic complication × 1, | |
Chen | LADG | 93 | 10 | Anastomosis leakage × 1, hemorrhage × 1, abdominal abscess × 3, pulmonary infection × 2,delayed gastric emptying × 2, lymphorrhea × 1 |
TLDG | 147 | 16 | Anastomosis leakage × 1, hemorrhage × 2, abdominal abscess × 2, pulmonary infection × 3,delayed gastric emptying × 4, lymphorrhea × 2, ileus × 1, pancreatic fistula × 1 | |
Zhang | LADG | 25 | 4 | Wound infection × 2,ileus × 2 |
TLDG | 11 | 1 | Duodenal stump leakage × 1 | |
Kanaji | LADG | 74 | 4 | Delayed gastric emptying × 1, wound infection × 2, acute pulmonary edema × 1 |
TLDG | 40 | 0 |