Effects of Laparoscopic versus Open Surgery for Advanced Gastric Cancer after Neoadjuvant Chemotherapy: A Meta-Analysis

Abstract

Objective. To evaluate the efficacy of laparoscopy and laparotomy after neoadjuvant chemotherapy in the treatment of advanced gastric cancer by meta-analysis. Methods. Cochrane Library, Embase, and PubMed were searched by computer until December 1, 2021. Literature was screened according to inclusion and exclusion criteria, and relevant data were extracted for meta-analysis using RevMan 5.3. Results. A total of 1027 patients from 11 literature studies were included in this study, including 413 patients in the laparoscopic group and 614 patients in the open group. Meta-analysis showed that the laparoscopic group had less intraoperative bleeding (SMD = −1.11; 95% CI: −1.75–0.47; $P=0.0006$ ), early postoperative exhaust (SMD = −0.45; 95% CI: −0.70–0.20; $P=0.0004$ ), and shorter postoperative hospital stay (SMD = 0.97; 95% CI: 1.69∼0.26; $P=0.008$ ), but had longer the operation time (SMD = 0.65; 95% CI: 0.52∼0.79; $P<0.00001$ ). There was no significant difference in the number of lymph nodes dissected during operation (SMD = −0.45; 95% CI: −0.42–0.19; $P=0.45$ ), the incidence of surgical complications 30 days after operation (OR = 0.78; 95% CI: 0.53∼1.13; $P=0.19$ ), time of first defecation (MD = 0.00; 95% CI: −0.10∼0.10; $P=0.98$ ), and time of first postoperative feeding (MD = −0.05; 95% CI: −0.22∼0.12; $P=0.54$ ) between the two groups. For long-term prognosis, there was no significant difference in the 3-year overall survival rate after operation between the two groups (RR = 0.84; 95% CI: 0.63–1.12; $P=0.23$ ). Conclusion. Compared with the open stomach cancer surgery, laparoscopic gastric cancer surgery has less intraoperative blood loss, shorter hospitalization time, and advantages such as early rehabilitation, postoperative complications rate, and long-term survival, which confirmed the validity and security of the laparoscopic surgery.