Long-term and short-term outcomes after laparoscopic versus open surgery for advanced gastric cancer: An updated meta-analysis

Background: The efficacy of laparoscopy for advanced gastric cancer (AGC) remains controversial. Materials and Methods: We conducted a literature search on the EMBASE, PubMed and Cochrane Library databases to identify relevant available articles published between the time of the databases' inception and July 2020. Results: A total of 14,689 patients were included in the 41 studies identified. A total of 6976 patients were in an laparoscopic approach group (LG) and 7713 patients were in an open approach group (OG). The meta-analysis showed that in randomized control trials (RCTs), LG were better than OG in terms of estimated blood loss, time to oral intake and time to first flatus while the operation time and proximal resection margin (PRM) were significantly worse in LG than in OG. In the non-RCTs, LG had shorter hospital stays, less blood loss, less intraoperative transfusion, less time to oral intake, time to first flatus, time to ambulation; less overall or serious complications; and better 3-year and 5-year overall or disease-free survival (DFS). Operation times and PRM were significantly worse for LGs. Conclusion: The safety and effectiveness of laparoscopic surgery for AGC is not inferior to that of traditional open surgery, and to a certain extent, can reduce trauma, facilitate recovery, and be validated in RCTs and non-RCTs. In the real-world cohort, laparoscopic surgery for gastric cancer achieved a better survival rate and DFS rate. However, to evaluate the efficacy of these two methods more comprehensively, high-quality randomized controlled trials and longer follow-up times are still needed.