Objective To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer. Methods The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis. Results A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss ［MD=–17.59, 95% CI (–30.81, –4.37), P=0.009］, shorter incision length ［MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01］, and earlier first anal exhaust time ［MD=–0.16, 95% CI (–0.28, –0.04), P=0.007］in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier ［MD=–0.47, 95% CI (–0.86, –0.08), P=0.02］ and the postoperative hospital stay of the TLTG group was shorter ［MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9］; In the TLTG group, the VAS score was lower on the first postoperative day ［MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01］ and on the third postoperative day ［MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01］. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05). Conclusions TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.
ObjectiveTo evaluate the safety and efficacy of transorally inserted anvil (OrVilTM) for laparoscopic total gastrectomy compared with open total gastrectomy.MethodsRetrospectively summarized the 285 gastric cancer patients from the Affiliated Hospital of Xuzhou Medical University between December 2012 and April 2018, of them 156 patients underwent laparoscopic total gastrectomy (being reconstructed by OrVilTM) via 129 patients underwent open total gastrectomy. Operation-associated parameters and postoperative complications were compared between the two groups.ResultsThe intraoperative blood loss was significantly less, proximal resection margin was significantly longer, and first ambulatory time, time to first flatus, time to fluid diet were significantly shorter in the laparoscopic total gastrectomy group (P<0.05). Whereas the total operative time, esophagojejunostomy time, numbers of dissected lymph nodes, time to remove drainage tube, length of postoperative hospital stay, and morbidity of postoperative complication (including anastomotic leakage, anastomotic stenosis, anastomotic bleeding, celiac and pleural effusion or infection) were not significantly different between the two groups (P>0.05).ConclusionOrVilTM is a technically safe and feasible surgical procedure for esophagojejunostomy in laparoscopic total gastrectomy.