Laparoscopic versus open surgery for gastric cancer in Western countries: a systematic review and meta-analysis of short- and long-term outcomes

Background. The advantages of a laparoscopic approach for the treatment of gastric cancer have already been demonstrated in Eastern Countries. This review and meta-analysis aims to merge all the western studies comparing laparoscopic (LG) versus open gastrectomies (OG) to provide pooled results and higher levels of evidence. Methods. A systematic literature search was performed in MEDLINE(PubMed), Embase, WebOfScience and Scopus for studies comparing laparoscopic versus open gastrectomy in western centers from 1980 to 2021. Results. After screening 355 articles, 34 articles with a total of 24,098 patients undergoing LG (5445) or OG (18,653) in western centers were included. Compared to open gastrectomy, laparoscopic gastrectomy has a significantly longer operation time (WMD = 47.46 min; 95% CI = 31.83-63.09; p < 0.001), lower blood loss (WMD = -129.32 mL; 95% CI = -188.11 to -70.53; p < 0.0001), lower analgesic requirement (WMD = -1.824 days; 95% CI = -2.314 to -1.334; p < 0.0001), faster time to first oral intake (WMD = -1.501 days; 95% CI = -2.571 to -0.431; p = 0.0060), shorter hospital stay (WMD = -2.335; 95% CI = -3.061 to -1.609; p < 0.0001), lower mortality (logOR = -0.261; 95% the -0.446 to -0.076; p = 0.0056) and a better 3-year overall survival (logHR 0.245; 95% CI = 0.016-0.474; p = 0.0360). A slight significant difference in favor of laparoscopic gastrectomy was noted for the incidence of postoperative complications (logOR = -0.202; 95% CI = -0.403 to -0.000 the = 0.0499). No statistical difference was noted based on the number of harvested lymph nodes, the rate of major postoperative complication and 5-year overall survival. Conclusions. In Western centers, laparoscopic gastrectomy has better short-term and equivalent long-term outcomes compared with the open approach, but more high-quality studies on long-term outcomes are required.