Laparoscopic vs open gastrectomy. An updated metaanalysis of randomised control trials for short term outcomes and updated metaanalysis for long term over all and disease free survival outcomes.
Introduction: Aim of this metaanalysis was to compare short term outcomes of laparoscopic and open gastrectomy for gastric cancer. Material and methods: EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for randomised control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30 day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2gastrectomies, lymphnode retrieval, operative time, distal gastrectomy, wound complications and intraabdominal complications Systemic review and Metaanalysis were done according to MOOSE and PRISMA guidelines. Results: Morbidity was significantly low in laparoscopic group( P=0.004).There was no significant difference between mortality between the two groups. (P=0.989). There less wound complications in laparoscpic group, no difference intra-abdominal complications in both the groups. Operative time was significantly higher in laparoscopic group.( P< 0.001) wmd 56.904. Hospital stay was similar in laparoscopic group. (P=0.305) wmd -0.533 days. Blood loss was significantly lesser in laparoscopic group.(p <0.001). Laparoscopic group patients had less number of lymph node retrieval compared to laparoscopic group.(p< 0.001). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies. Conclusions: Laparoscopic gastrectomies were associated with better short term outcomes.
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